Healthcare Provider Details

I. General information

NPI: 1265425953
Provider Name (Legal Business Name): ANGELOS ALEXANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N HIGHLAND AVE
AURORA IL
60506-3814
US

IV. Provider business mailing address

3040 MAJESTIC OAKS LN
ST CHARLES IL
60174-7964
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-4355
  • Fax: 630-892-4355
Mailing address:
  • Phone: 847-878-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036029052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: