Provider Demographics
NPI:1396023420
Name:D'ANGELO, ANNE-LISE D (MD)
Entity Type:Individual
Prefix:
First Name:ANNE-LISE
Middle Name:D
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE-LISE
Other - Middle Name:D
Other - Last Name:MAAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:507-284-0702
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60000-20208600000X
MN63590208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery