Healthcare Provider Details

I. General information

NPI: 1538943444
Provider Name (Legal Business Name): MARY LOUDER, DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 PINEHILL DR
HOLLAND MI
49424-1348
US

IV. Provider business mailing address

2695 PINEHILL DR
HOLLAND MI
49424-1348
US

V. Phone/Fax

Practice location:
  • Phone: 616-201-8955
  • Fax: 616-207-3341
Mailing address:
  • Phone: 303-827-8158
  • Fax: 616-207-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY LOUDER
Title or Position: PHYSICIAN AND OWNER
Credential: DO
Phone: 616-201-8955