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General NPI Number Information
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NPI Number | 1467650614
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Entity Type | Organization
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Legal Business Name | MARY K O'CALLAGHAN DO PC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 922 LAWNDALE ST
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City | LUDINGTON
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State | MI
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Zip | 49431-1928
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Country | US
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Telephone | 231-845-7380
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Fax |
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Provider Business Mailing Address
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Address Line | 922 LAWNDALE ST
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City | LUDINGTON
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State | MI
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Zip | 49431-1928
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Country | US
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Telephone | 231-845-7380
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARY KEATING O'CALLAGHAN
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Credential | D.O.
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Telephone | 231-845-7380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 009391
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License Number State | MI
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