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NPI Code Detail

MEDICARE: DR. ANGELA HALIBURDA D.O.

MEDICARE: DR. ANGELA HALIBURDA D.O.
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
1207LP2900XPain Medicine (Anesthesiology) Physician48462MN

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 : 1548210628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA HALIBURDA D.O.
Provider Business Mailing Address
First Line : 226 CAVIL WAY
Second Line :
City : DE PERE
State : WI
Zip : 54115-3772
Country : US
Telephone Number : 920-351-0289
Fax Number :
Provider Business Practice Location Address
First Line : 1260 32ND AVE N
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-1649
Country : US
Telephone Number : 320-230-7788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 08/22/2008

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