Individual
AUDREY LISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
787 MARKET ST STE 9, HANCOCK, MI 49930
(906) 482-7762
Mailing address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101012074
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829560001
MEDICARE DME
MI
01
—
0C16002
MEDICARE GROUP
MI
05
—
114387160
—
MI
01
—
AL012074
BLUE CROSS STATE ID
MI
Enumeration date
08/18/2006
Last updated
01/16/2019
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