MEDICARE: DR. MARK E ANGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	35066771A	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154315661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E ANGEL M.D.

Provider Business Mailing Address
First Line	:	36100 EUCLID AVE
Second Line	:	#300
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4456
Country	:	US
Telephone Number	:	440-942-5400
Fax Number	:	440-942-9055

Provider Business Practice Location Address
First Line	:	36100 EUCLID AVE
Second Line	:	#300
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4456
Country	:	US
Telephone Number	:	440-942-5400
Fax Number	:	440-942-9055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/14/2007

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