Provider Demographics
NPI:1619083185
Name:AUGUSTINE, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:AUGUSTINE
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 1:1650 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-7316
Mailing Address - Country:US
Mailing Address - Phone:920-320-4500
Mailing Address - Fax:920-320-4584
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:920-682-9378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI00001598648 02OtherUNITED HEALTH
WI080126370OtherMEDICARE RAILROAD
WI31852600Medicaid
WI390806395OtherCHAMPUS
WI390806395OtherWEA
WIF31064OtherCIGNA
WI390806395008OtherTRICARE
WI33601OtherTOUCHPOINT
WI7413OtherNETWORK HEALTH
WI390806395OtherWEA
WI000138170Medicare ID - Type Unspecified