Provider Demographics
NPI:1114129913
Name:CHAVEZ, ANGELA K (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:WIDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:19895 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1815
Mailing Address - Country:US
Mailing Address - Phone:440-356-5500
Mailing Address - Fax:
Practice Address - Street 1:19895 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1815
Practice Address - Country:US
Practice Address - Phone:440-356-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00568207Q00000X
NH16497207Q00000X
OH34.009411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine