Provider Demographics
NPI:1902020837
Name:ISABELLE M. AUDET MD PC
Entity Type:Organization
Organization Name:ISABELLE M. AUDET MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUDET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-678-8150
Mailing Address - Street 1:809 W DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8961
Mailing Address - Country:US
Mailing Address - Phone:810-678-8150
Mailing Address - Fax:810-678-2972
Practice Address - Street 1:809 W DRYDEN RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8961
Practice Address - Country:US
Practice Address - Phone:810-678-8150
Practice Address - Fax:810-678-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P27460Medicare PIN