Basic Information
| Provider Information | |||||||||
| NPI: | 1891776837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSBAN | ||||||||
| FirstName: | ANGELINA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185467000 | ||||||||
| FaxNumber: | 2185464400 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185467000 | ||||||||
| FaxNumber: | 2185464400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 41796 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 41796 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1089016 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | BA4231483 | 01 | DEA | OTHER | 156625300 | 01 | MEDICAL ASSISTANCE | OTHER | 2129272 | 01 | FIRST HEALTH PLAN | OTHER | P00054868 | 01 | RAILROAD MEDICARE | OTHER | HP36173 | 01 | HEALTH PARTNERS | OTHER | 1024776 | 01 | PREFERRED ONE | OTHER | 127K8AU | 01 | BLUE CROSS BLUE SHIELD | OTHER | 160518 | 01 | UCARE | OTHER | 0405874 | 01 | MEDICA HEALTH PLANS | OTHER |