Provider Demographics
NPI:1346251071
Name:ANG, STEPHEN T (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:ANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1054 M L KING DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3000
Mailing Address - Country:US
Mailing Address - Phone:618-532-1688
Mailing Address - Fax:618-532-1689
Practice Address - Street 1:1054 M L KING DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3000
Practice Address - Country:US
Practice Address - Phone:618-532-1688
Practice Address - Fax:618-532-1689
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06107347OtherBLUE CROSS BLUE SHIELD
G25820Medicare UPIN
IL466860Medicare ID - Type Unspecified