Healthcare Provider Details

I. General information

NPI: 1538345160
Provider Name (Legal Business Name): MICHAEL A AUSTERLITZ MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4588 WHITTIER BLVD
LOS ANGELES CA
90022-2430
US

IV. Provider business mailing address

4588 WHITTIER BLVD
LOS ANGELES CA
90022-2430
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-2917
  • Fax:
Mailing address:
  • Phone: 323-265-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA25290
License Number StateCA

VIII. Authorized Official

Name: MICHAEL AUGUST AUSTERLITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 323-265-2917