Provider Demographics
NPI:1225133440
Name:ANGELIN, PETER I (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:I
Last Name:ANGELIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 411582
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3582
Mailing Address - Country:US
Mailing Address - Phone:314-583-9968
Mailing Address - Fax:314-485-1154
Practice Address - Street 1:2345 DOUGHERTY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3313
Practice Address - Country:US
Practice Address - Phone:314-655-4486
Practice Address - Fax:314-485-1154
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003010400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208829200Medicaid