Individual
LORI E VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1000
Mailing address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301083871
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C16002
MEDICARE GROUP
MI
01
—
4301083871
STATE LICENSE
MI
01
—
700C16002
BCBSM GROUP
MI
01
—
LV083871
BLUE CROSS STATE ID
MI
Enumeration date
03/16/2007
Last updated
06/03/2013
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