Provider Demographics
NPI:1609854280
Name:CHUDLER, ANGEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:CHUDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3354
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-953-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014519207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11-4615004Medicaid
MI11-4615013Medicaid
MI11-4615022Medicaid
MI0158211355OtherBCBS
MI11-4615031Medicaid
MI11-4614992Medicaid
MI11-4614992Medicaid
MIL09532Medicare UPIN
MI11-4615013Medicaid