Provider Demographics
NPI:1568441764
Name:PACE, ANGELO V (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:V
Last Name:PACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2519
Mailing Address - Country:US
Mailing Address - Phone:561-278-3323
Mailing Address - Fax:561-274-3963
Practice Address - Street 1:900 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2519
Practice Address - Country:US
Practice Address - Phone:561-278-3323
Practice Address - Fax:561-274-3963
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16325207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036154200Medicaid
FLD55718Medicare UPIN
FL036154200Medicaid