Organization
DOMENICO S AUSIELLO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE ANDRES (CREDENTIALING/BILLING)
(616) 754-6949
Entity
Organization
Contact information
Practice address
200 S FRANKLIN ST, GREENVILLE, MI 48838-1740
(616) 754-6949
(616) 754-1062
Mailing address
200 S FRANKLIN ST, GREENVILLE, MI 48838-1740
(616) 754-6949
(616) 754-1062
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301053623
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0590023
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
05
—
2751016
—
MI
Enumeration date
12/21/2010
Last updated
12/21/2010
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