1609219690 NPI number — BERNADETTE ANGELES MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609219690 NPI number — BERNADETTE ANGELES MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNADETTE ANGELES MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609219690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21723 GARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-595-5215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42450 W 12 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48377-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-513-4100
Provider Business Practice Location Address Fax Number:
248-513-4105
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELES
Authorized Official First Name:
BERNADETTE
Authorized Official Middle Name:
LOURDES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-595-5215

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4301074466 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com