Individual
MARY IRENE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5635 W FORT ST, DETROIT, MI 48209-3154
(313) 849-3920
(313) 849-0824
Mailing address
5635 W FORT ST, DETROIT, MI 48209-3154
(313) 849-3920
(313) 848-0824
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704221993
MI
Other
Enumeration date
10/24/2007
Last updated
12/04/2012
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