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General NPI Number Information
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NPI Number | 1902853252
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Entity Type | Individual
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Provider Name | MARY E PETTY-DUDLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 3 HERITAGE DR SUITE 1
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City | SOUTHGATE
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State | MI
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Zip | 48195-3000
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Country | US
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Telephone | 734-283-3222
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Fax | 734-283-4006
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Provider Business Mailing Address
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Address Line | 30274 YOUNG DR
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City | GIBRALTAR
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State | MI
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Zip | 48173-9457
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Country | US
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Telephone | 313-831-8303
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Fax | 313-831-8307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MP058113
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License Number State | MI
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