Petty-Dudley, Mary E
Petty-Dudley, Mary E is an sole proprietor health care provider with primary practice located at 3 Heritage Dr Suite 1, Southgate MI 48195-3000. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Petty-Dudley, Mary E can be contacted via phone (734) 283-3222.Contact Information
Primary practice address
3 Heritage Dr Suite 1
Southgate MI 48195-3000
Phone: (734) 283-3222
Fax: (734) 283-4006
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MP058113 | Michigan |
Profile Details
| NPI number | 1902853252 |
|---|---|
| LBN Legal business name | Petty-Dudley, Mary E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 30th, 2006 |
| Last updated | Jul 31st, 2019 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902853252 | NPPES |
| Michigan | Other | 110825451 | BCBS |
| Michigan | Other | 102435 | BCBS |
| Michigan | Other | MP058113 | BCBS |
| Michigan | MEDICAID | 4503142 TYPE 10 | BCBS |
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