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Organization

E. A. AUSTIN DO PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CYNTHIA JEAN CONQUEST (PRACTICE MANAGER)
(231) 935-0340
Entity
Organization

Contact information

Practice address
110 S MADISON ST, TRAVERSE CITY, MI 49684-2340
(231) 946-0911
(231) 935-0343
Mailing address
110 S MADISON ST, TRAVERSE CITY, MI 49684-2340
(231) 946-0911
(231) 935-0343

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
5101017642
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1477715076
MI
Enumeration date
07/12/2016
Last updated
07/12/2016
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