Provider Demographics
NPI:1497731418
Name:AMALAKUMAR D. AUGUSTINE, MD, LLC
Entity Type:Organization
Organization Name:AMALAKUMAR D. AUGUSTINE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMALAKUMAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-469-2182
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE. 670 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-469-2182
Mailing Address - Fax:314-469-5725
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:STE. 670 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-469-2182
Practice Address - Fax:314-469-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5589OtherRAILROAD MEDICARE
DE5589OtherRAILROAD MEDICARE