Provider Demographics
NPI:1447214143
Name:MORREALE, ANGELO PAUL (DPM)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:PAUL
Last Name:MORREALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52313
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2313
Mailing Address - Country:US
Mailing Address - Phone:318-797-3668
Mailing Address - Fax:318-797-7977
Practice Address - Street 1:725 N ASHLEY RIDGE LOOP
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7232
Practice Address - Country:US
Practice Address - Phone:318-797-3668
Practice Address - Fax:318-797-7977
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPDO64R213E00000X
LADPMPDO64R213ES0103X, 213ES0131X, 213EP1101X, 213ER0200X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1905801Medicaid
6443890001Medicare NSC
T19729Medicare UPIN
LA0860820001Medicare NSC
56585DL99Medicare PIN
LA0860820002Medicare NSC
LA56585Medicare PIN
6443890002Medicare NSC