Provider Demographics
NPI:1114338126
Name:SANJUAN, ANGIELYN MAUREEN (DO)
Entity Type:Individual
Prefix:
First Name:ANGIELYN
Middle Name:MAUREEN
Last Name:SANJUAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:224-251-4568
Practice Address - Street 1:9650 GROSS POINT RD STE 2900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:224-251-4568
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036157260207XP3100X
UT11778300-1204207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery