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Individual

DR. M.ANTONIA AUSUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
519 W MAIN ST, MILAN, MI 48160-9559
(734) 439-1543
(734) 439-0553
Mailing address
519 W MAIN ST, P.O. BOX 16, MILAN, MI 48160-9559
(734) 439-1543
(734) 439-0553

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13291
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110788
AETNA-DMO
MI
05
2602947
MI
Enumeration date
01/26/2007
Last updated
07/08/2007
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