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General NPI Number Information
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NPI Number | 1023767415
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Entity Type | Individual
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Provider Name | AUGUSTIN DOUGLAS HERNANDEZ DO
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Gender | Male
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 215 WASHINGTON ST
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City | GRAFTON
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State | WI
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Zip | 53024-1700
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Country | US
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Telephone | 262-375-3700
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Fax | 262-376-6032
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 81446-21
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License Number State | WI
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