Individual
MARY MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3937 PATIENT CARE DR, LANSING, MI 48911
(517) 394-6484
(517) 394-7785
Mailing address
3937 PATIENT CARE DR, LANSING, MI 48911
(517) 394-6484
(517) 394-7785
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
043750
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C31319
BCBS
MI
01
—
0C313191
BCN
MI
01
—
1200190
PHP
MI
01
—
1270190
COMMERCIAL INSURANCE
MI
01
—
201963697
COMMERCIAL INS
MI
05
—
4711314
—
MI
01
—
5817732
COMMERCIAL
MI
01
—
MM043750
COMMERCIAL
MI
01
—
P58952
BCN
MI
Enumeration date
08/30/2006
Last updated
07/09/2007
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