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General NPI Number Information
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NPI Number | 1023250339
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Entity Type | Organization
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Legal Business Name | PAUL D ANGELCHIK MD PC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 18275 N 59TH AVE SUIT 170 BLDG L
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 602-237-5888
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Fax | 602-277-8146
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Provider Business Mailing Address
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Address Line | PO BOX 39179
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City | PHOENIX
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State | AZ
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Zip | 85069-9179
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Country | US
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Telephone | 602-395-0718
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Fax | 602-277-8146
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Authorized Official
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Title or Position | SUPERVISOR
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Name | SHANNON WHITE
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Credential |
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Telephone | 602-443-2325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 22382
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License Number State | AZ
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