Healthcare Provider Details

I. General information

NPI: 1780637876
Provider Name (Legal Business Name): MARY A CAMERON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22821 ORCHARD LAKE RD
FARMINGTON MI
48336-3230
US

IV. Provider business mailing address

41600 RAYBURN DR
NORTHVILLE MI
48168-2080
US

V. Phone/Fax

Practice location:
  • Phone: 248-615-6600
  • Fax: 248-615-6605
Mailing address:
  • Phone: 734-934-2579
  • Fax: 248-615-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301076620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: