# MARY WONDERLY MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912167750
- **Authorized official:** DENISE KERLIN (OFFICE MANAGER)
- **Authorized official phone:** (419) 332-3560

## Contact information

- **Practice address:** 2575 HAYES AVE STE 5, FREMONT, OH 43420-5201
- **Practice address phone:** (419) 332-3560
- **Practice address fax:** (419) 332-3565
- **Mailing address:** 2575 HAYES AVE STE 5, FREMONT, OH 43420-5201
- **Mailing address phone:** (419) 332-3560
- **Mailing address fax:** (419) 332-3565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35-082561 | OH | Yes |

## Other

- **Enumeration date:** 06/16/2008
- **Last updated:** 11/26/2008