Provider Demographics
NPI:1588654594
Name:SWEENEY, ANGIE R (MD)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:R
Last Name:SWEENEY
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Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 375
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-662-4200
Mailing Address - Fax:248-662-0368
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 375
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-662-4200
Practice Address - Fax:248-662-0368
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-08-05
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Provider Licenses
StateLicense IDTaxonomies
MI4301070456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4895614Medicaid
MIH26505OtherHEALTH ALLIANCE PLAN
H26505Medicare UPIN
MIH26505OtherHEALTH ALLIANCE PLAN