MEDICARE: ANDREW CHRISTOPHER ANGEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	R6896	KY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1003669417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CHRISTOPHER ANGEL MD

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 HANDY RD
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-8789
Country	:	US
Telephone Number	:	859-325-3620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	01/07/2026

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