Individual
DR. MARY KATHLEEN MCTIGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
(812) 331-0196
Mailing address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
(812) 331-0196
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01039092A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
01039092A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100345180
—
IN
Enumeration date
06/09/2005
Last updated
05/19/2023
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