MEDICARE: DR. ANGELA M PORTER 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	207R00000X	Internal Medicine Physician	AP064427	MI
2	208D00000X	General Practice Physician	4301064427	MI

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	:	1578561015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M PORTER MD

Provider Business Mailing Address
First Line	:	6820 OYSTER CV
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2051
Country	:	US
Telephone Number	:	313-333-0620
Fax Number	:	248-322-3071

Provider Business Practice Location Address
First Line	:	46156 WOODWARD AVE
Second Line	:	SUITE B
City	:	PONTIAC
State	:	MI
Zip	:	48342-5033
Country	:	US
Telephone Number	:	248-322-6747
Fax Number	:	248-322-3071

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/08/2017

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