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General NPI Number Information
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NPI Number | 1508077140
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Entity Type | Organization
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Legal Business Name | ANGELA BADRA DO, PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 204 W EXCHANGE ST
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City | OWOSSO
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State | MI
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Zip | 48867-2818
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Country | US
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Telephone | 989-723-0046
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Fax | 989-723-0052
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Provider Business Mailing Address
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Address Line | 204 W EXCHANGE ST
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City | OWOSSO
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State | MI
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Zip | 48867-2818
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Country | US
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Telephone | 989-723-0046
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Fax | 989-723-0052
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA BADRA
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Credential | DO
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Telephone | 989-723-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101012489
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License Number State | MI
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