Provider Demographics
NPI:1487697959
Name:AUSTIN, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 E NORTHLAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8426
Mailing Address - Country:US
Mailing Address - Phone:920-734-8714
Mailing Address - Fax:920-734-8785
Practice Address - Street 1:1301 E NORTHLAND AVE
Practice Address - Street 2:STE A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8426
Practice Address - Country:US
Practice Address - Phone:920-734-8714
Practice Address - Fax:920-734-8785
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-12-02
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Provider Licenses
StateLicense IDTaxonomies
WI33602207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32890500Medicaid
WI180030240OtherRAILROAD MEDICARE
WI32890500Medicaid
WIF13485Medicare UPIN