Provider Demographics
NPI:1699961607
Name:AUSE, ROBERT GORDON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GORDON
Last Name:AUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3613
Mailing Address - Country:US
Mailing Address - Phone:734-327-3400
Mailing Address - Fax:734-327-3278
Practice Address - Street 1:806 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3613
Practice Address - Country:US
Practice Address - Phone:734-327-3400
Practice Address - Fax:734-327-3278
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010266282085H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1117607Medicaid
MI1117607Medicaid