MEDICARE: STEPHEN P ANGEL MD INC A MEDICAL CORPORATION

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	207R00000X	Internal Medicine Physician	G30448	CA

General Provider Information

NPI Number	:	1235445172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN P ANGEL MD INC A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	320 SUPERIOR AVE STE 320
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2742
Country	:	US
Telephone Number	:	949-548-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 SUPERIOR AVE STE 320
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2742
Country	:	US
Telephone Number	:	949-548-9396
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN P ANGEL
Credential	:	MD
Telephone Number	:	949-548-9396

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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