Provider Demographics
NPI:1437147378
Name:ANGELL, LINDA K (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2723 S STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:800-551-7347
Mailing Address - Fax:
Practice Address - Street 1:1515 LAKE LANSING RD
Practice Address - Street 2:SUITE H
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3753
Practice Address - Country:US
Practice Address - Phone:800-551-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049568207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4579740Medicaid
MI180C846310OtherBCBSM
MI1437147378Medicaid
P00242561OtherRAILROAD MEDICARE
B47793Medicare UPIN
MI180C846310OtherBCBSM
MI4579740Medicaid