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Organization

MARY E PETTY MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARY EVELYN PETTY M.D. (PHYSICIAN)
(734) 283-3222
Entity
Organization

Contact information

Practice address
3 HERITAGE DR, SUITE 1, SOUTHGATE, MI 48195-3000
(734) 283-3222
(734) 283-4006
Mailing address
PO BOX 193, ROCKWOOD, MI 48173-0193
(734) 283-3222
(734) 283-4006

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MP058113
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
102435
GREAT LAKES
MI
05
4157286
MI
05
4887167
MI
01
7503086
AETNA
MI
01
MP058113
BCBS
Enumeration date
06/10/2006
Last updated
06/30/2015
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