MEDICARE: VICTOR R ANGELES 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	2084N0400X	Neurology Physician	37612	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000333566	OTHER	KY	ANTHEM
3	2444879000	OTHER	KY	PASSPORT ADVANTAGE
4	50003444	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1922003532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR R ANGELES MD

Provider Business Mailing Address
First Line	:	908 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1479
Country	:	US
Telephone Number	:	270-230-0212
Fax Number	:	270-230-0104

Provider Business Practice Location Address
First Line	:	908 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1479
Country	:	US
Telephone Number	:	270-230-0212
Fax Number	:	270-230-0104

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/01/2012

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Directions to “ VICTOR R ANGELES MD” Practice Location

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