MEDICARE: BRAD ANGLE MD

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	208000000X	Pediatrics Physician	036069741	IL
2	207SG0201X	Clinical Genetics (M.D.) Physician	036069741	IL

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	:	1427026897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD ANGLE MD

Provider Business Mailing Address
First Line	:	1875 DEMPSTER ST STE 285
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1157
Country	:	US
Telephone Number	:	847-723-7705
Fax Number	:	847-723-8675

Provider Business Practice Location Address
First Line	:	1875 DEMPSTER ST STE 285
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1157
Country	:	US
Telephone Number	:	847-723-7705
Fax Number	:	847-723-8675

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/21/2022

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Directions to “ BRAD ANGLE MD” Practice Location

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