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NPI Code Detail

MEDICARE: ANGELO P MORREALE, DPM, A PROF CORP

MEDICARE: ANGELO P MORREALE, DPM, A PROF CORP
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
1213EP1101XPrimary Podiatric Medicine Podiatrist
2213ER0200XRadiology Podiatrist
3213ES0000XSports Medicine Podiatrist
4213ES0131XFoot Surgery Podiatrist
5332B00000XDurable Medical Equipment & Medical Supplies
6332BC3200XCustomized Equipment (DME)
7335E00000XProsthetic/Orthotic Supplier
8213ES0103XFoot & Ankle Surgery Podiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C6593OTHERLABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1477517175
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGELO P MORREALE, DPM, A PROF CORP
Provider Business Mailing Address
First Line : PO BOX 2817
Second Line :
City : NATCHITOCHES
State : LA
Zip : 71457-0817
Country : US
Telephone Number : 318-357-9559
Fax Number : 318-357-1263
Provider Business Practice Location Address
First Line : 422 DIXIE PLZ
Second Line :
City : NATCHITOCHES
State : LA
Zip : 71457-5881
Country : US
Telephone Number : 318-357-9559
Fax Number : 318-357-1263
Authorized Official
Title or Position : OWNER PRESIDENT
Name : ANGELO PAUL MORREALE
Credential : DPM
Telephone Number : 318-357-9559
Provider Enumeration Date : 04/12/2006
Last Update Date : 03/09/2018

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