Active NPI
Mary E Petty MD PC
- Family Medicine Physician
- Southgate, MI
National Provider Identifier
1710928544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MP058113
- Legal business name
- MARY E PETTY MD PC
- Practice address
- 3 Heritage Dr
Suite 1
Southgate, MI 48195-3000 - Phone
- (734) 283-3222
- Fax
- (734) 283-4006
- NPI assigned
- Jun 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mary Evelyn Petty, M.D.
- Title
- Physician
- Phone
- (734) 283-3222
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MP058113 | MI | Primary |
Addresses
Primary practice location
3 Heritage Dr
Suite 1
Southgate, MI 48195-3000
Mailing address
PO Box 193
Rockwood, MI 48173-0193
Phone (734) 283-3222
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MP058113 | Other | BCBS | |
| 102435 | Other | MI | GREAT LAKES |
| 4157286 | Medicaid | MI | |
| 4887167 | Medicaid | MI | |
| 7503086 | Other | MI | AETNA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Saginaw, MI
- NPI 1184811499
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1435622400000",
"number": "1710928544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 193",
"city": "ROCKWOOD",
"state": "MI",
"postal_code": "481730193",
"telephone_number": "734-283-3222",
"fax_number": "734-283-4006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 HERITAGE DR",
"address_2": "SUITE 1",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481953000",
"telephone_number": "734-283-3222",
"fax_number": "734-283-4006"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARY E PETTY MD PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-10",
"last_updated": "2015-06-30",
"status": "A",
"authorized_official_last_name": "PETTY",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "EVELYN",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "734-283-3222",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MI",
"license": "MP058113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "MP058113",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES",
"identifier": "102435",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4157286",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4887167",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7503086",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.