Provider Demographics
NPI:1881604577
Name:SIM, AUDREY MULLIN (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MULLIN
Last Name:SIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:25915 HARPER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3770
Mailing Address - Country:US
Mailing Address - Phone:586-872-2580
Mailing Address - Fax:586-872-2689
Practice Address - Street 1:25915 HARPER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3770
Practice Address - Country:US
Practice Address - Phone:586-872-2580
Practice Address - Fax:586-872-2689
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-04-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301073033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47411Medicare UPIN