Provider Demographics
NPI:1962405670
Name:DOLORFINO, AUGUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTIN
Middle Name:
Last Name:DOLORFINO
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 1:307 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8502
Mailing Address - Country:US
Mailing Address - Phone:231-878-8237
Mailing Address - Fax:
Practice Address - Street 1:520 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2588
Practice Address - Country:US
Practice Address - Phone:231-775-6521
Practice Address - Fax:231-876-6519
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI120877OtherPREFFERED CHOICE BILLING
MIAD406733OtherBLUE CROSS BILLING NUMBER
MI19788OtherPRIORITY HEALTH BILLING
MI4085098Medicaid
MI4085098OtherMOLINA
MI4085098OtherMOLINA