Provider Demographics
NPI:1770933574
Name:FANNING, AURIELLE MARIE (MD)
Entity type:Individual
Prefix:
First Name:AURIELLE
Middle Name:MARIE
Last Name:FANNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AURIELLE
Other - Middle Name:MARIE
Other - Last Name:MCCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:313-369-3950
Practice Address - Street 1:IHA EAST BRIGHTON PRIMARY CARE
Practice Address - Street 2:5505 S OLD US 23 SUITE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-494-6885
Practice Address - Fax:313-369-0142
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine