Healthcare Provider Details

I. General information

NPI: 1659866945
Provider Name (Legal Business Name): ETZER MICHELET AUGUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W OAK ST
KISSIMMEE FL
34741-4024
US

IV. Provider business mailing address

86 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-944-5200
  • Fax: 407-944-5250
Mailing address:
  • Phone: 321-841-5142
  • Fax: 407-648-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN27316
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME179181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: