Provider Demographics
NPI:1184864076
Name:MOORE, ANGELA SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:D'ANNUNZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3510 N RIDGE ROAD, SUITE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-881-8180
Mailing Address - Fax:316-881-8239
Practice Address - Street 1:3510 N RIDGE ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-881-8180
Practice Address - Fax:316-881-8329
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0534062207Q00000X
CO47165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200639670AMedicaid
1184864076OtherNPI