Healthcare Provider Details

I. General information

NPI: 1962405670
Provider Name (Legal Business Name): AUGUSTIN DOLORFINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COBB ST
CADILLAC MI
49601-2588
US

IV. Provider business mailing address

307 LAKEWOOD DR
CADILLAC MI
49601-8502
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6521
  • Fax: 231-876-6519
Mailing address:
  • Phone: 231-878-8237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301406733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: