Individual
DR. MARY ANNE PURTILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 E MICHIGAN AVE, STE 201, JACKSON, MI 49201-1847
(517) 817-7605
(517) 817-7606
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
(517) 817-7605
(517) 817-7606
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G076836
CA
2086S0127X
Trauma Surgery Physician
Primary
4301075397
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZP4310Z
MEDICARE ID - STANFORD SURGERY DEPT
CA
Enumeration date
05/27/2005
Last updated
03/14/2013
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