Healthcare Provider Details

I. General information

NPI: 1407919285
Provider Name (Legal Business Name): ANGELO MILAZZO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 CREEKSTONE DR STE 300
DURHAM NC
27703-0016
US

IV. Provider business mailing address

4709 CREEKSTONE DR STE 300
DURHAM NC
27703-0016
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-1269
  • Fax: 919-862-5355
Mailing address:
  • Phone: 919-862-1269
  • Fax: 919-862-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number97-01496
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97-01496
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number9701496
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: