Healthcare Provider Details

I. General information

NPI: 1568669794
Provider Name (Legal Business Name): CELESTE A ANGEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 GRANADA ST
LEAWOOD KS
66211-1453
US

IV. Provider business mailing address

11550 GRANADA ST
LEAWOOD KS
66211-1453
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-7546
  • Fax: 913-663-2411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number05-32519
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: