Healthcare Provider Details

I. General information

NPI: 1538131206
Provider Name (Legal Business Name): ANDRES E ANGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDRES E ANGEL MEJIA MD

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

IV. Provider business mailing address

PO BOX 742291
ATLANTA GA
30374-2291
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-4120
  • Fax: 941-505-1466
Mailing address:
  • Phone: 941-766-4120
  • Fax: 941-766-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME94425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: