Provider Demographics
NPI:1841678133
Name:AUSTIN, ALFRED (DO)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2603
Mailing Address - Country:US
Mailing Address - Phone:989-329-6546
Mailing Address - Fax:
Practice Address - Street 1:8235 HOLLY RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9700
Practice Address - Fax:910-694-9940
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315218427208600000X
MI5101025663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery