Provider Demographics
NPI:1881186005
Name:VAVRO, ERIN ALLISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ALLISE
Last Name:VAVRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:ALLISE
Other - Last Name:VAVRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:35050 23 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3606
Mailing Address - Country:US
Mailing Address - Phone:586-725-0477
Mailing Address - Fax:
Practice Address - Street 1:35050 23 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3606
Practice Address - Country:US
Practice Address - Phone:586-725-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-03-22
Deactivation Date:2018-06-06
Deactivation Code:
Reactivation Date:2018-06-12
Provider Licenses
StateLicense IDTaxonomies
MI4301503501207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty