Provider Demographics
NPI:1528066156
Name:RUPP, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:RUPP
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:205 W GRAND RIVER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1647
Mailing Address - Country:US
Mailing Address - Phone:810-225-7773
Mailing Address - Fax:810-225-7774
Practice Address - Street 1:205 W GRAND RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1647
Practice Address - Country:US
Practice Address - Phone:810-225-7773
Practice Address - Fax:810-225-7774
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P12410001Medicare PIN
MIG58915Medicare UPIN