Healthcare Provider Details

I. General information

NPI: 1043846140
Provider Name (Legal Business Name): JEREMY ANGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

515 DAYTON ST
HAMILTON OH
45011-3455
US

IV. Provider business mailing address

515 DAYTON ST
HAMILTON OH
45011-3455
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-7654
  • Fax: 513-737-0026
Mailing address:
  • Phone: 513-868-7654
  • Fax: 513-737-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: