MEDICARE: ANGELO A PETROPOLIS 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	207N00000X	Dermatology Physician	22192	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0776240	OTHER		BCBS AZ
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	516118	OTHER	AZ	AETNA

General Provider Information

NPI Number	:	1457391732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO A PETROPOLIS MD

Provider Business Mailing Address
First Line	:	7300 RANCH ROAD 2222, BUILDING 1, STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730
Country	:	US
Telephone Number	:	512-628-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635
Country	:	US
Telephone Number	:	520-458-1505
Fax Number	:	520-458-6949

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/20/2023

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Directions to “ ANGELO A PETROPOLIS MD” Practice Location

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