MEDICARE: DR. NATHAN CHRISTOPHER DEANGELIS D.O.

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	208600000X	Surgery Physician	OS11555	FL
2	208600000X	Surgery Physician	125-051776	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063651131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN CHRISTOPHER DEANGELIS D.O.

Provider Business Mailing Address
First Line	:	4106 W LAKE MARY BLVD STE 100
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3344
Country	:	US
Telephone Number	:	407-562-5930
Fax Number	:	407-562-5931

Provider Business Practice Location Address
First Line	:	4106 W LAKE MARY BLVD STE 100
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3344
Country	:	US
Telephone Number	:	407-562-5930
Fax Number	:	407-562-5931

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

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	01/19/2026

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