Provider Demographics
NPI:1083654222
Name:CORTES, ANGEL MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MANUEL
Last Name:CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:MANUEL
Other - Last Name:CORTES ROBLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:7714 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8422
Practice Address - Country:US
Practice Address - Phone:407-745-4581
Practice Address - Fax:407-745-4583
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14344208D00000X
FLACN473208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD373ZOtherMEDICARE PTAN
PR500109SEOtherMMM
FL008388700Medicaid
PR21057OtherTRIPLE S
FLHD373ZOtherMEDICARE PTAN
FL008388700Medicaid