Healthcare Provider Details

I. General information

NPI: 1871579896
Provider Name (Legal Business Name): AMALAKUMAR D AUGUSTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MARR LN
SAINT CHARLES MO
63303-9000
US

IV. Provider business mailing address

22 MARR LN
SAINT CHARLES MO
63303-9000
US

V. Phone/Fax

Practice location:
  • Phone: 636-926-1316
  • Fax: 636-926-1322
Mailing address:
  • Phone: 636-926-1316
  • Fax: 636-926-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number110935
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: