Provider Demographics
NPI:1710142765
Name:SYLVESTER, ANGELA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1836
Mailing Address - Country:US
Mailing Address - Phone:630-930-5600
Mailing Address - Fax:
Practice Address - Street 1:1339 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1836
Practice Address - Country:US
Practice Address - Phone:630-930-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
400280OtherMEDICARE GROUP PTAN