Individual
AUDREY L FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
39901 TRADITIONS DR, NORTHVILLE, MI 48168-9493
(734) 998-2020
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301078173
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4631723
—
MI
Enumeration date
10/12/2006
Last updated
03/19/2024
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