Provider Demographics
NPI:1508077140
Name:ANGELA BADRA DO, PC
Entity Type:Organization
Organization Name:ANGELA BADRA DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-723-0046
Mailing Address - Street 1:204 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2818
Mailing Address - Country:US
Mailing Address - Phone:989-723-0046
Mailing Address - Fax:989-723-0052
Practice Address - Street 1:204 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2818
Practice Address - Country:US
Practice Address - Phone:989-723-0046
Practice Address - Fax:989-723-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00209171OtherRAILROAD MEDICARE
MIG63641Medicare UPIN
MIP00209171OtherRAILROAD MEDICARE