Healthcare Provider Details

I. General information

NPI: 1356504427
Provider Name (Legal Business Name): MARY SHORT-RAY D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 LITTLE LAKE DR SUITE 5
ANN ARBOR MI
48103-6219
US

IV. Provider business mailing address

180 LITTLE LAKE DRIVE SUITE 5
ANN ARBOR MI
48103
US

V. Phone/Fax

Practice location:
  • Phone: 734-904-2496
  • Fax: 248-363-1393
Mailing address:
  • Phone: 734-904-2496
  • Fax: 248-363-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5101011718
License Number StateMI

VIII. Authorized Official

Name: MARY E. SHORT
Title or Position: PHYSICIAN/PRESIDENT
Credential:
Phone: 734-904-2496