Provider Demographics
NPI:1073683470
Name:REYES, ANGELO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:B
Last Name:REYES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6001
Mailing Address - Fax:913-359-5552
Practice Address - Street 1:5801 WASHINGTON AVE
Practice Address - Street 2:STE 99
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4010
Practice Address - Country:US
Practice Address - Phone:913-359-6001
Practice Address - Fax:913-359-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-12-28
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Provider Licenses
StateLicense IDTaxonomies
IL036096782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG13723Medicare UPIN