MEDICARE: ANN M AUBURN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	AA011643	MI

General Provider Information

NPI Number	:	1518967660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN M AUBURN D.O.

Provider Business Mailing Address
First Line	:	4466 HERITAGE CT SW STE D
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2383
Country	:	US
Telephone Number	:	616-301-0808
Fax Number	:	616-301-7887

Provider Business Practice Location Address
First Line	:	4466 HERITAGE CT SW STE D
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2383
Country	:	US
Telephone Number	:	616-301-0808
Fax Number	:	616-301-7887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/15/2019

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