| Doctor Name: | DR. MARY ANN R DOMINGO |
| NPI Number: | 1053396127 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 01061323A |
| Business Practice Address: | 6913 N Main St Granger, IN - 465308039 |
| Business Phone Number: | 5746471500 |
| Business Fax Number: | |
| Mailing Address: | 710 N Niles Ave, SOUTH BEND |
| State: | IN |
| Postal Code: | 466171924 |
| Phone Number: | 5746471610 |
| Fax Number: | |
| NPI Enumeration Date: | 12/13/2005 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RR0500X |
| License Number: | 01061323A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Rheumatology |
| Taxonomy Definition: | An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |