MEDICARE: DR. MARY ELIZABETH THORNE M.D.

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
1	207Q00000X	Family Medicine Physician	4301050887	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0803306961	OTHER	MI	BCBS INDIVIDUAL PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972609683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH THORNE M.D.

Provider Business Mailing Address
First Line	:	1280 CHARTWELL CARRIAGE WAY NORTH
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2404
Country	:	US
Telephone Number	:	517-337-2030
Fax Number	:	517-337-2030

Provider Business Practice Location Address
First Line	:	1280 CHARTWELL CARRIAGE WAY NORTH
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2404
Country	:	US
Telephone Number	:	517-337-2030
Fax Number	:	517-337-2030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/03/2009

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