Provider Demographics
NPI:1811947773
Name:WHITTWELL, AUGUSTO ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:ENRIQUE
Last Name:WHITTWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A. ENRIQUE
Other - Middle Name:
Other - Last Name:WHITTWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:SUITE 416
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:305-665-0100
Mailing Address - Fax:305-665-0149
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 416
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-665-0100
Practice Address - Fax:305-665-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04735OtherNHP
FL24735OtherHEALTHEASE
FL532025OtherFIRST HEALTH
FL285407OtherAVMED
FL02808OtherBLUE CROSS BLUE SHIELD
FL24735OtherWELLCARE
FL3973039OtherCIGNA
FL24735OtherSTAYWELL
FL20220171OtherBEECH STREET
FL4676858OtherAETNA
FL02808ZMedicare PIN
FL285407OtherAVMED