MEDICARE: MS. LORI MICHELLE MAUSI M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036-107300	IL
2	207V00000X	Obstetrics & Gynecology Physician	4301072113	MI

General Provider Information

NPI Number	:	1861464984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI MICHELLE MAUSI M.D.

Provider Business Mailing Address
First Line	:	3601 W 13 MILE RD
Second Line	:	400 FSC
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6712
Country	:	US
Telephone Number	:	248-423-2481
Fax Number	:	248-551-5158

Provider Business Practice Location Address
First Line	:	3535 W 13 MILE RD
Second Line	:	STE 329
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-5549
Fax Number	:	248-551-5158

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	10/22/2020

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