MEDICARE: ANGELA HARDEN-MACK 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	20206	WV
2	207R00000X	Internal Medicine Physician	35.152589	OH

General Provider Information

NPI Number	:	1750383840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA HARDEN-MACK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201096
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-9096
Country	:	US
Telephone Number	:	540-664-9215
Fax Number	:	540-536-0061

Provider Business Practice Location Address
First Line	:	3411 WELLNESS WAY STE B1
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-9547
Country	:	US
Telephone Number	:	419-423-5344
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/13/2025

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