Provider Demographics
NPI:1629121645
Name:DAHLE, ANGELA MCCOY (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MCCOY
Last Name:DAHLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:952-893-1959
Mailing Address - Fax:952-832-0249
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-893-1959
Practice Address - Fax:952-832-0249
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46341207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8D852DAOtherBCBS
MNHP40935OtherHEALTHPARTNERS
960081040599OtherPREFERREDONE
MN968163900Medicaid
139339OtherUCARE