Provider Demographics
NPI:1093747149
Name:ANGELES, BERNADETTE L (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:L
Last Name:ANGELES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOURDES BERNADETTE
Other - Middle Name:S
Other - Last Name:ANGELES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:42450 W 12 MILE RD
Mailing Address - Street 2:315
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3013
Mailing Address - Country:US
Mailing Address - Phone:248-513-4100
Mailing Address - Fax:248-513-4105
Practice Address - Street 1:42450 W 12 MILE RD
Practice Address - Street 2:315
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3013
Practice Address - Country:US
Practice Address - Phone:248-513-4100
Practice Address - Fax:248-513-4105
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010744662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry