Provider Demographics
NPI:1073512752
Name:ANGELES, DAISY S (MD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:S
Last Name:ANGELES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2016
Mailing Address - Country:US
Mailing Address - Phone:313-563-1033
Mailing Address - Fax:313-563-2930
Practice Address - Street 1:1039 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2016
Practice Address - Country:US
Practice Address - Phone:313-563-1033
Practice Address - Fax:313-563-2930
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1361633Medicaid
MIM87970001Medicare ID - Type Unspecified
MIA73600Medicare UPIN