Healthcare Provider Details

I. General information

NPI: 1134414964
Provider Name (Legal Business Name): ABIGAIL SUZANNE ANGULO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE # 140
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE # 140
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 847-477-4576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-059445
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberDR0053900
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: