Provider Demographics
NPI:1386708477
Name:DONIGAN, MARY K (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:DONIGAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6301 UNIVERSITY COMMONS
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1571
Mailing Address - Country:US
Mailing Address - Phone:574-232-4800
Mailing Address - Fax:574-280-4810
Practice Address - Street 1:6301 UNIVERSITY COMMONS
Practice Address - Street 2:SUITE 360
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1571
Practice Address - Country:US
Practice Address - Phone:574-232-4800
Practice Address - Fax:574-280-4810
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN23001421A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100338000Medicaid
IN000000085508OtherANTHEM PIN