Provider Demographics
NPI:1154513364
Name:AUSTEN, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:AUSTEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:4647 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3816
Practice Address - Country:US
Practice Address - Phone:941-745-5999
Practice Address - Fax:941-745-3555
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2017-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME118122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS828XMedicare PIN