Provider Demographics
NPI:1093781460
Name:STEVENS, ANGELA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8091 TOWNSHIP LINE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2495
Mailing Address - Country:US
Mailing Address - Phone:317-415-1000
Mailing Address - Fax:317-415-1010
Practice Address - Street 1:8091 TOWNSHIP LINE RD STE 206
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2495
Practice Address - Country:US
Practice Address - Phone:317-415-1000
Practice Address - Fax:317-415-1010
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052874A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200294880Medicaid
IN677690FFMedicare PIN
IN160050227Medicare PIN
INH23098Medicare UPIN