MEDICARE: SIRPA T. AUTIO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME88275	FL

General Provider Information

NPI Number	:	1134158405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRPA T. AUTIO MD

Provider Business Mailing Address
First Line	:	21 HOSPITAL DR
Second Line	:	SUITE 120
City	:	PALM COAST
State	:	FL
Zip	:	32164-2452
Country	:	US
Telephone Number	:	386-586-4280
Fax Number	:	386-586-4286

Provider Business Practice Location Address
First Line	:	500 N MUNDO
Second Line	:
City	:	DULCE
State	:	NM
Zip	:	87528-0187
Country	:	US
Telephone Number	:	575-759-3291
Fax Number	:	575-759-3532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/11/2025

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