Provider Demographics
NPI:1568554517
Name:ANGLES, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:ANGLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1150
Mailing Address - Country:US
Mailing Address - Phone:816-361-3833
Mailing Address - Fax:816-333-7512
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:SUITE 320
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1150
Practice Address - Country:US
Practice Address - Phone:816-361-3833
Practice Address - Fax:816-333-7512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD109993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG38313Medicare UPIN
MO0009363Medicare ID - Type Unspecified