Provider Demographics
NPI:1477532927
Name:DELLANGELO, ROBERT CHARLES
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:DELLANGELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 347
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-4512
Mailing Address - Fax:906-225-4514
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 347
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-4512
Practice Address - Fax:906-225-4514
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI044231207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1552205Medicaid
E26572Medicare UPIN
MI1552205Medicaid