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NPI Code Detail

MEDICARE: ELEAZAR SAN-AGUSTIN M.D.

MEDICARE: ELEAZAR SAN-AGUSTIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician21832WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083761365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEAZAR SAN-AGUSTIN M.D.
Provider Business Mailing Address
First Line : 4390 DRUID CT
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-1548
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4929 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2324
Country : US
Telephone Number : 414-871-6122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 07/08/2007

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Directions to “ ELEAZAR SAN-AGUSTIN M.D.” Practice Location

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