Active NPI
Mary E Petty-Dudley, M.D.
- Internal Medicine Physician
- Southgate, MI
National Provider Identifier
1902853252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MP058113
- Practice address
- 3 Heritage Dr
Suite 1
Southgate, MI 48195-3000 - Phone
- (734) 283-3222
- Fax
- (734) 283-4006
- NPI assigned
- May 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MP058113 | MI | Primary |
Addresses
Primary practice location
3 Heritage Dr
Suite 1
Southgate, MI 48195-3000
Mailing address
30274 Young Dr
Gibraltar, MI 48173-9457
Phone (313) 831-8303
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110825451 | Other | MI | BCBS |
| 102435 | Other | MI | GREAT LAKES |
| MP058113 | Other | MI | BCBS |
| 4503142 TYPE 10 | Medicaid | MI |
Other names 1
- Dr. Mary E Petty
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MP058113 | MI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770854400000",
"number": "1902853252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30274 YOUNG DR",
"city": "GIBRALTAR",
"state": "MI",
"postal_code": "481739457",
"telephone_number": "313-831-8303",
"fax_number": "313-831-8307"
},
{
"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": {
"last_name": "PETTY-DUDLEY",
"first_name": "MARY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-30",
"last_updated": "2026-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "MP058113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "110825451",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES",
"identifier": "102435",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "MP058113",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4503142 TYPE 10",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "PETTY",
"middle_name": "E",
"prefix": "DR.",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}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 Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.