MEDICARE: NICHOLAS D'ANGELO M.D.

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	ME121379	FL

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	:	1689940595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS D'ANGELO M.D.

Provider Business Mailing Address
First Line	:	18610 NW 87TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3518
Country	:	US
Telephone Number	:	184-466-5482
Fax Number	:	186-692-0058

Provider Business Practice Location Address
First Line	:	18610 NW 87TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3518
Country	:	US
Telephone Number	:	184-466-5482
Fax Number	:	186-692-0058

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

Provider Enumeration Date	:	03/25/2012
Last Update Date	:	06/29/2016

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