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NPI Code Detail

MEDICARE: MICHAEL ALON ANGELO M.D.

MEDICARE: MICHAEL ALON ANGELO M.D.
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
1207Q00000XFamily Medicine Physician025219LA

Other Identifiers

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

General Provider Information

NPI Number : 1295723955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ALON ANGELO M.D.
Provider Business Mailing Address
First Line : 4438 VIKING DR STE 300
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-7510
Country : US
Telephone Number : 318-918-0015
Fax Number : 318-963-0015
Provider Business Practice Location Address
First Line : 1000 CHINABERRY DR STE 800
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2455
Country : US
Telephone Number : 318-392-3372
Fax Number : 318-392-3373
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 04/17/2024

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