Provider Demographics
NPI:1356838601
Name:SANTOS, ANGELIE AZUNCION M (MD)
Entity Type:Individual
Prefix:
First Name:ANGELIE AZUNCION
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELIE AZUNCION
Other - Middle Name:MIRASOL
Other - Last Name:MANALOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1830
Practice Address - Country:US
Practice Address - Phone:608-262-5420
Practice Address - Fax:608-262-5624
Is Sole Proprietor?:No
Enumeration Date:2018-04-21
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75115-20207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356838601Medicaid