Provider Demographics
NPI:1316050966
Name:WOOD, MARY C (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2200 LONG LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1927
Mailing Address - Country:US
Mailing Address - Phone:248-334-6594
Mailing Address - Fax:248-977-3079
Practice Address - Street 1:39575 WEST TEN MILE ROAD
Practice Address - Street 2:#205
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2949
Practice Address - Country:US
Practice Address - Phone:248-477-4411
Practice Address - Fax:248-477-4413
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1383550Medicaid
MI1383550Medicaid
B44347Medicare UPIN