Healthcare Provider Details

I. General information

NPI: 1114163151
Provider Name (Legal Business Name): ANGELA MACCARONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

1546 LOVELL CRESCENT
LASALLE ONTARIO
N9H 2M8
CA

V. Phone/Fax

Practice location:
  • Phone: 248-967-7783
  • Fax:
Mailing address:
  • Phone: 519-250-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4704209142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: