Provider Demographics
NPI:1366635310
Name:NATALIE, AUGUST ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:ANTHONY
Last Name:NATALIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:8325 S EMERSON AVE STE C1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8559
Practice Address - Country:US
Practice Address - Phone:317-780-7400
Practice Address - Fax:317-859-8181
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075404A207N00000X, 207N00000X
PAMD445623207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology