Healthcare Provider Details

I. General information

NPI: 1871529511
Provider Name (Legal Business Name): MARI ELIZABETH DOUMA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 SAGINAW ST STE 202
LANSING MI
48917
US

IV. Provider business mailing address

B545 W FEE HALL
EAST LANSING MI
48824-1315
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-7711
  • Fax: 517-321-7799
Mailing address:
  • Phone: 517-353-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101012036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: