Individual
DR. MARY ANN R DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6901 N MAIN ST STE 102, GRANGER, IN 46530-8022
(574) 647-4500
(574) 647-6354
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01061323A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200537970
—
IN
Enumeration date
12/13/2005
Last updated
08/07/2025
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