MEDICARE: DR. AUGUST ANTHONY NATALIE MD

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
1	207N00000X	Dermatology Physician	01075404A	IN

General Provider Information

NPI Number	:	1366635310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUST ANTHONY NATALIE MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	8325 S EMERSON AVE STE C1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8559
Country	:	US
Telephone Number	:	317-780-7400
Fax Number	:	317-859-8181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	03/03/2026

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