MEDICARE: MICHAEL ANGELO APMC

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	207Q00000X	Family Medicine Physician	MD.025219	LA

General Provider Information

NPI Number	:	1548775828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL ANGELO APMC

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	318-424-5449
Fax Number	:	855-230-1466

Provider Business Practice Location Address
First Line	:	2525 VIKING DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2103
Country	:	US
Telephone Number	:	318-841-2525
Fax Number	:	318-425-8438

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL ANGELO
Credential	:	MD
Telephone Number	:	318-469-7997

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/08/2017

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