Provider Demographics
NPI:1891898409
Name:ATTIAH, AUGUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:ATTIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2707 BOLTON BOONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DE SOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:972-296-3633
Mailing Address - Fax:972-780-0649
Practice Address - Street 1:2707 BOLTON BOONE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DE SOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-296-3633
Practice Address - Fax:972-780-0649
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG6815207R00000X, 207RP1001X, 207RC0200X
IN01075958A207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033369201Medicaid
C13005Medicare UPIN
TX00FP09Medicare ID - Type Unspecified