Provider Demographics
NPI:1619902855
Name:MADANGUIT, AURORA B (MD)
Entity Type:Individual
Prefix:
First Name:AURORA
Middle Name:B
Last Name:MADANGUIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-8700
Mailing Address - Country:US
Mailing Address - Phone:269-202-7014
Mailing Address - Fax:269-202-7130
Practice Address - Street 1:6572 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-8717
Practice Address - Country:US
Practice Address - Phone:269-202-7014
Practice Address - Fax:269-202-7130
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068832207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4341536Medicaid
MI0M39190OtherMEDICARE GROUP
MI4341536Medicaid
MIM39190011Medicare PIN