Basic Information
| Provider Information | |||||||||
| NPI: | 1316380595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUGUSTINE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MERCHANT ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135331199 | ||||||||
| FaxNumber: | 5136459787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3248 WESTBOURNE DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452485140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136623900 | ||||||||
| FaxNumber: | 5136623933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 213E00000X | 36.003763 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.