1962405670 NPI number — DR. AUGUSTIN DOLORFINO MD

Table of content: DR. AUGUSTIN DOLORFINO MD (NPI 1962405670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962405670 NPI number — DR. AUGUSTIN DOLORFINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLORFINO
Provider First Name:
AUGUSTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962405670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 LAKEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CADILLAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49601-8502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-878-8237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 COBB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADILLAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49601-2588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-775-6521
Provider Business Practice Location Address Fax Number:
231-876-6519
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301406733 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120877 . This is a "PREFFERED CHOICE BILLING" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AD406733 . This is a "BLUE CROSS BILLING NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 19788 . This is a "PRIORITY HEALTH BILLING" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4085098 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4085098 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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