1053495671 NPI number — AUBURN NEUROLOGY ASSOCIATES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053495671 NPI number — AUBURN NEUROLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUBURN NEUROLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053495671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27101 SCHOENHERR AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48088-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-754-5900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27101 SCHOENHERR AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48088-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-459-7444
Provider Business Practice Location Address Fax Number:
734-459-7755
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORSON
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-459-7444

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  TM067838 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4914120 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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