Provider Demographics
NPI:1417068990
Name:D'ALESSANDRO, ANGELO A (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:A
Last Name:D'ALESSANDRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E 21ST ST STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1302
Mailing Address - Country:US
Mailing Address - Phone:918-744-0575
Mailing Address - Fax:918-744-0576
Practice Address - Street 1:1560 E 21ST ST STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1302
Practice Address - Country:US
Practice Address - Phone:918-744-0575
Practice Address - Fax:918-744-0576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE09701Medicare UPIN