Provider Demographics
NPI:1548458904
Name:DOUGLAS E. PUGMIRE DO PLLC
Entity type:Organization
Organization Name:DOUGLAS E. PUGMIRE DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUGMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-372-9967
Mailing Address - Street 1:1515 LAKE LANSING RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3753
Mailing Address - Country:US
Mailing Address - Phone:517-372-9967
Mailing Address - Fax:517-372-0669
Practice Address - Street 1:1515 LAKE LANSING RD
Practice Address - Street 2:SUITE O
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3753
Practice Address - Country:US
Practice Address - Phone:517-372-9967
Practice Address - Fax:517-372-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013693207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5330168OtherBLUE CROSS BLUE SHIELD
MI114258903Medicaid
MI200000002555OtherPHP OF MID MICHIGAN
MI5330168OtherBLUE CARE NETWORK
MI114258903Medicaid
MI0N80370Medicare PIN