Provider Demographics
NPI:1538345160
Name:MICHAEL A AUSTERLITZ MD, INC
Entity type:Organization
Organization Name:MICHAEL A AUSTERLITZ MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:AUSTERLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-265-2917
Mailing Address - Street 1:4588 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2430
Mailing Address - Country:US
Mailing Address - Phone:323-265-2917
Mailing Address - Fax:
Practice Address - Street 1:4588 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2430
Practice Address - Country:US
Practice Address - Phone:323-265-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25290207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADV651AMedicare PIN