Provider Demographics
NPI:1891776837
Name:AUSBAN, ANGELINA G (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:G
Last Name:AUSBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441
Mailing Address - Country:US
Mailing Address - Phone:218-546-7000
Mailing Address - Fax:218-546-4400
Practice Address - Street 1:320 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-546-4400
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41796208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1089016OtherARAZ GROUP AMERICAS PPO
156625300OtherMEDICAL ASSISTANCE
2129272OtherFIRST HEALTH PLAN
P00054868OtherRAILROAD MEDICARE
HP36173OtherHEALTH PARTNERS
1024776OtherPREFERRED ONE
127K8AUOtherBLUE CROSS BLUE SHIELD
160518OtherUCARE
0405874OtherMEDICA HEALTH PLANS
0405874OtherMEDICA HEALTH PLANS
1024776OtherPREFERRED ONE
127K8AUOtherBLUE CROSS BLUE SHIELD