Healthcare Provider Details

I. General information

NPI: 1548458904
Provider Name (Legal Business Name): DOUGLAS E. PUGMIRE DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912-3753
US

IV. Provider business mailing address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912-3753
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-9967
  • Fax: 517-372-0669
Mailing address:
  • Phone: 517-372-9967
  • Fax: 517-372-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number5101013693
License Number StateMI

VIII. Authorized Official

Name: DR. DOUGLAS E PUGMIRE
Title or Position: OWNER
Credential: D.O.
Phone: 517-372-9967