Healthcare Provider Details

I. General information

NPI: 1912908781
Provider Name (Legal Business Name): THOMAS MICHAEL ANGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVENUE 2ND FLOOR
ST JOHN IN
46373-9487
US

IV. Provider business mailing address

9660 WICKER AVENUE 2ND FLOOR
ST JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-226-2380
  • Fax: 219-226-2380
Mailing address:
  • Phone: 219-226-2380
  • Fax: 219-226-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01029884
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: