Provider Demographics
NPI:1942463682
Name:AUGUSTE, KURTIS IAN (MD)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:IAN
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 52ND STREET
Mailing Address - Street 2:SUITE 5203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-428-3319
Mailing Address - Fax:510-597-7034
Practice Address - Street 1:744 52ND STREET
Practice Address - Street 2:SUITE 5203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-428-3319
Practice Address - Fax:510-597-7034
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82763207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A827630Medicaid