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General NPI Number Information
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NPI Number | 1164458352
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Entity Type | Individual
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Provider Name | MICHAEL A AGOSTINO MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 18051 RIVER ROAD SUITE 104
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City | NOBLESVILLE
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State | IN
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Zip | 46062-7093
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Country | US
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Telephone | 317-844-7059
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Fax | 317-819-0044
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Provider Business Mailing Address
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Address Line | 10201 N ILLINOIS ST STE 110
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City | CARMEL
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State | IN
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Zip | 46290-1172
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Country | US
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Telephone | 317-844-7059
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Fax | 317-819-0044
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01038563
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License Number State | IN
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