Provider Demographics
NPI:1467684894
Name:D'ANGELO, CHRISTOPHER PAUL (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:D'ANGELO
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 1:93 KENSINGTON BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1220
Mailing Address - Country:US
Mailing Address - Phone:734-223-8010
Mailing Address - Fax:
Practice Address - Street 1:93 KENSINGTON BLVD. UNIT #2
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069
Practice Address - Country:US
Practice Address - Phone:734-223-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315041798OtherSTATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
MI5101018412OtherSTATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH