MEDICARE: ANGELA SHREVES 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	207R00000X	Internal Medicine Physician	12982	AZ

General Provider Information

NPI Number	:	1285634840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SHREVES MD

Provider Business Mailing Address
First Line	:	5620 W THUNDERBIRD RD
Second Line	:	F1
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4636
Country	:	US
Telephone Number	:	602-938-6960
Fax Number	:	602-938-6069

Provider Business Practice Location Address
First Line	:	5620 W THUNDERBIRD RD
Second Line	:	F1
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4636
Country	:	US
Telephone Number	:	602-938-6960
Fax Number	:	602-938-6069

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2013

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