Individual
MARY PATRICIA MORTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
406545
MI
207RG0100X
Gastroenterology Physician
Primary
4301406545
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020022
MIDWEST HEALTH PLAN
MI
01
—
0812110
BCBS INDIVIDUAL
MI
01
—
0H14989
BCBS GROUP
MI
01
—
10004002
MEDICARE RAILROAD PTAN
MI
01
—
2359882001
CIGNA
MI
05
—
2769932
—
MI
01
—
4404019
AETNA
MI
Enumeration date
01/13/2006
Last updated
04/24/2023
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