| Domenico S Ausiello Md Pc | |
|
200 S Franklin St Greenville MI 48838-1740 | |
| (616) 754-6949 | |
| (616) 754-1062 |
| Full Name | Domenico S Ausiello Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 200 S Franklin St, Greenville, Michigan |
| Authorized Official Name and Position | Diane Andres (CREDENTIALING/BILLING) |
| Authorized Official Contact | 6167546949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Domenico S Ausiello Md Pc 200 S Franklin St Greenville MI 48838-1740 Ph: (616) 754-6949 | Domenico S Ausiello Md Pc 200 S Franklin St Greenville MI 48838-1740 Ph: (616) 754-6949 |
| NPI Number | 1972806594 |
|---|---|
| Provider Enumeration Date | 12/21/2010 |
| Last Update Date | 12/21/2010 |
| Medicare PECOS PAC ID | 3577747104 |
|---|---|
| Medicare Enrollment ID | O20110406000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972806594 | NPI | - | NPPES |
| 0590023 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 2751016 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301053623 (Michigan) | Primary |
| Provider Name | Domenico S Ausiello |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144254095 PECOS PAC ID: 7618950221 Enrollment ID: I20110104001307 |
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