Provider Demographics
NPI:1225165525
Name:MEDICAL OFFICES OF JOHN DEANGELIS
Entity Type:Organization
Organization Name:MEDICAL OFFICES OF JOHN DEANGELIS
Other - Org Name:PAIN LIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-656-7702
Mailing Address - Street 1:3048 E BASELINE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7286
Mailing Address - Country:US
Mailing Address - Phone:480-756-8966
Mailing Address - Fax:480-756-8999
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:480-756-8966
Practice Address - Fax:480-756-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1023106986Medicare ID - Type Unspecified