Individual
MARION E. MAHONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7913
(574) 647-6819
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01071886A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000878115
BCBS BMG E BLAIR WARNER
IN
05
—
201107650
—
IN
01
—
261970051
MEDICARE PTAN
IN
Enumeration date
06/15/2010
Last updated
08/07/2023
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