Healthcare Provider Details

I. General information

NPI: 1518463090
Provider Name (Legal Business Name): AUSTIN MARCOLINA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 120TH AVE STE 20
HOLLAND MI
49424-2196
US

IV. Provider business mailing address

370 120TH AVE STE 20
HOLLAND MI
49424-2196
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-5855
  • Fax:
Mailing address:
  • Phone: 616-396-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.072538
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBP10066768
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20034
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101027616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: