Provider Demographics
NPI:1861679078
Name:DAVID A. VAN AUKER
Entity Type:Organization
Organization Name:DAVID A. VAN AUKER
Other - Org Name:GENESIS PROSTHETIC ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN AUKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CP, CCA
Authorized Official - Phone:517-540-6190
Mailing Address - Street 1:2106 MUSSON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-9082
Mailing Address - Country:US
Mailing Address - Phone:517-540-6190
Mailing Address - Fax:517-540-6191
Practice Address - Street 1:2106 MUSSON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-9082
Practice Address - Country:US
Practice Address - Phone:517-540-6190
Practice Address - Fax:517-540-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4593040001Medicare NSC