Domingo, Mary Ann R

Domingo, Mary Ann R is an individual health care provider with primary practice located at 6901 N Main St Ste 102 , Granger IN 46530-8022. She recently has only one registered license in Allopathic & Osteopathic Physicians / Rheumatology, which is considered as her primary health care specialty. Domingo, Mary Ann R can be contacted via phone (574) 647-4500.

Contact Information

Primary practice address
6901 N Main St Ste 102 Granger IN 46530-8022
Phone: (574) 647-4500
Fax: (574) 647-6354
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X 01061323A Indiana

Profile Details

NPI number 1053396127
LBN Legal business name Domingo, Mary Ann R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Apr 1st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053396127 NPPES
Indiana Other 000000803598 BCBS MAIN STREET
Indiana MEDICAID 200537970 BCBS MAIN STREET

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