Provider Demographics
NPI:1093791519
Name:ANGLES, MARIA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MICHELLE
Last Name:ANGLES
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 1:359 MEDICAL GROUP
Mailing Address - Street 2:221 THIRD STREET WEST, BLDG.1040
Mailing Address - City:JOINT BASE SAN ANTONIO-RANDOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:210-652-9386
Mailing Address - Fax:210-652-9836
Practice Address - Street 1:359 MEDICAL GROUP
Practice Address - Street 2:221 THIRD STREET WEST, BLDG.1040
Practice Address - City:JOINT BASE SAN ANTONIO-RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15725207R00000X
LA024485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine