MEDICARE: JOSEPH R ANGELO II 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
1	2080P0210X	Pediatric Nephrology Physician	FTL 43259	TX

General Provider Information

NPI Number	:	1760790927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH R ANGELO II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:	713-500-8630

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	500
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7111
Fax Number	:

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

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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