Provider Demographics
NPI:1003092966
Name:DONALD C AUSTIN MD PC
Entity Type:Organization
Organization Name:DONALD C AUSTIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-954-4677
Mailing Address - Street 1:96 NORTHBOUND GRATIOT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2349
Mailing Address - Country:US
Mailing Address - Phone:586-954-4677
Mailing Address - Fax:586-954-4678
Practice Address - Street 1:96 NORTHBOUND GRATIOT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2349
Practice Address - Country:US
Practice Address - Phone:586-954-4677
Practice Address - Fax:586-954-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100141OtherGREAT LAKES HEALTH PLAN
MI1405021311OtherBLUE CROSS BLUE SHIELD
MI1039073Medicaid
MI21741OtherOMNICARE
MI1405021311OtherBLUE CROSS BLUE SHIELD
MI1405021311OtherBLUE CROSS BLUE SHIELD
MI0P17230Medicare PIN