Healthcare Provider Details

I. General information

NPI: 1508964701
Provider Name (Legal Business Name): MARY PUGMIRE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 445
LANSING MI
48912-1800
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5210
  • Fax: 517-364-5216
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101013713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: