Provider Demographics
NPI:1508846106
Name:AUGUSTINO, MICHAEL FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:AUGUSTINO
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 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 360A
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-436-7667
Mailing Address - Fax:954-889-0131
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:#360A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-436-7667
Practice Address - Fax:954-889-0131
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47828207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055969500Medicaid
FL07240OtherBCBS
FL07240RMedicare PIN
FL07240OtherBCBS
D21183Medicare UPIN
FL055969500Medicaid
FL07240QMedicare PIN
FL07240XMedicare PIN
FL07240OMedicare PIN
FL07240UMedicare PIN
FL07240TMedicare PIN
FL07240SMedicare PIN
FL07240VMedicare PIN
07240NMedicare PIN
FL07240PMedicare PIN