Healthcare Provider Details

I. General information

NPI: 1316574296
Provider Name (Legal Business Name): ANGEL MANUEL VIGO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 LOOKOUT DR
NORTH MANKATO MN
56003-2503
US

IV. Provider business mailing address

PO BOX 8674
MANKATO MN
56002-8674
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-1811
  • Fax: 507-625-6282
Mailing address:
  • Phone: 507-389-8507
  • Fax: 507-625-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80711
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: