Provider Demographics
NPI:1689860140
Name:MILES, ANGELA S
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:S
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:S
Other - Last Name:WITKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 US HIGHWAY 46
Mailing Address - Street 2:SUITE G52
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1668
Mailing Address - Country:US
Mailing Address - Phone:973-588-7268
Mailing Address - Fax:973-588-7268
Practice Address - Street 1:30045 HARPER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1649
Practice Address - Country:US
Practice Address - Phone:586-498-9133
Practice Address - Fax:586-771-0120
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003432237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689860140Medicaid