Provider Demographics
NPI:1659510998
Name:ANGELO SOYANGCO,M.D.
Entity Type:Organization
Organization Name:ANGELO SOYANGCO,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOYANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-343-5583
Mailing Address - Street 1:834 N SEMINARY ST
Mailing Address - Street 2:STE 401
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-343-5583
Mailing Address - Fax:309-343-4276
Practice Address - Street 1:834 N SEMINARY ST
Practice Address - Street 2:STE 401
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-343-5583
Practice Address - Fax:309-343-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085833207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085833Medicaid
IL1730293986OtherNPI
IL04800014OtherBCBS
IL1730293986OtherNPI
IL209047Medicare PIN