Provider Demographics
NPI:1528010568
Name:STOYANOVICH, ANGELO (DO)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:STOYANOVICH
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 1:14049 E 13 MILE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-5876
Mailing Address - Country:US
Mailing Address - Phone:586-558-9966
Mailing Address - Fax:586-558-5534
Practice Address - Street 1:14049 E 13 MILE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-5876
Practice Address - Country:US
Practice Address - Phone:586-558-9966
Practice Address - Fax:586-558-5534
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4475066Medicaid
MION65790Medicare ID - Type UnspecifiedCOMMON PROVIDER NUMBER
E25527Medicare UPIN