Individual
LORETTA A MULLALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5525 E PECK RD, CROSWELL, MI 48422
(810) 679-2950
(810) 679-2960
Mailing address
5525 E PECK RD, CROSWELL, MI 48422
(810) 679-2950
(810) 679-2960
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
LM051024
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0762000
BCBSM
—
05
—
2684076
—
MI
Enumeration date
04/05/2006
Last updated
06/09/2008
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