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NPI Code Detail

MEDICARE: MARY K O'CALLAGHAN DO PC

MEDICARE: MARY K O'CALLAGHAN DO PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician009391MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DG2738OTHERMIMEDICARE RR GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15530004OTHERMIBCBS #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41155300045OTHERMIBC GROUP

General Provider Information

NPI Number : 1467650614
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY K O'CALLAGHAN DO PC
Provider Business Mailing Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Provider Business Practice Location Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : DR. MARY KEATING O'CALLAGHAN
Credential : D.O.
Telephone Number : 231-845-7380
Provider Enumeration Date : 07/10/2007
Last Update Date : 03/07/2023

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Directions to “MARY K O'CALLAGHAN DO PC ” Practice Location

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