MEDICARE: MICHAEL J ANGULO

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	2255A2300X	Athletic Trainer		FL

General Provider Information

NPI Number	:	1396260592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J ANGULO

Provider Business Mailing Address
First Line	:	9729 N NEW RIVER CANAL RD APT 626
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3444
Country	:	US
Telephone Number	:	407-218-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	9729 N NEW RIVER CANAL RD APT 626
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3444
Country	:	US
Telephone Number	:	407-218-0767
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	07/21/2022

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