Provider Demographics
NPI:1871579896
Name:AUGUSTINE, AMALAKUMAR D (MD)
Entity type:Individual
Prefix:
First Name:AMALAKUMAR
Middle Name:D
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 1:22 MARR LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-9000
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00300665OtherRAILROAD MEDICARE
MO909164484Medicare ID - Type Unspecified
G88522Medicare UPIN