Provider Demographics
NPI:1427026897
Name:ANGLE, BRAD (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:ANGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST STE 285
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1157
Mailing Address - Country:US
Mailing Address - Phone:847-723-7705
Mailing Address - Fax:847-723-8675
Practice Address - Street 1:1875 DEMPSTER ST STE 285
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1157
Practice Address - Country:US
Practice Address - Phone:847-723-7705
Practice Address - Fax:847-723-8675
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069741208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069741Medicaid
F85128Medicare UPIN
IL036069741Medicaid