Provider Demographics
NPI:1861464984
Name:MAUSI, LORI MICHELLE (MD)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MICHELLE
Last Name:MAUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3601 W 13 MILE RD
Mailing Address - Street 2:400 FSC
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-423-2481
Mailing Address - Fax:248-551-5158
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE 329
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-5549
Practice Address - Fax:248-551-5158
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107300207V00000X
MI4301072113207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH73213Medicare UPIN