MEDICARE: ANTHEM MEDICAL MANAGEMENT INC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1255679031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHEM MEDICAL MANAGEMENT INC

Provider Business Mailing Address
First Line	:	1483 S FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6003
Country	:	US
Telephone Number	:	561-629-7267
Fax Number	:	561-629-7954

Provider Business Practice Location Address
First Line	:	1483 S FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6003
Country	:	US
Telephone Number	:	561-629-7267
Fax Number	:	561-629-7954

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOISE W ANGLADE
Credential	:	MD
Telephone Number	:	561-629-7267

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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