MEDICARE: ANGELA AZOR

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	036151870	IL

General Provider Information

NPI Number	:	1710392444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA AZOR

Provider Business Mailing Address
First Line	:	101 COLES CENTRE DR
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9314
Country	:	US
Telephone Number	:	217-540-2350
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 COLES CENTRE DR
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9314
Country	:	US
Telephone Number	:	217-540-2350
Fax Number	:

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

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	01/10/2022

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Directions to “ ANGELA AZOR ” Practice Location

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