Provider Demographics
NPI:1730312240
Name:DANGELO, MARK SALVATORE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SALVATORE
Last Name:DANGELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 E PARKDALE AVE STE L100
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-8904
Mailing Address - Country:US
Mailing Address - Phone:231-398-1750
Mailing Address - Fax:
Practice Address - Street 1:1345 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9318
Practice Address - Country:US
Practice Address - Phone:231-398-1750
Practice Address - Fax:231-398-1736
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203641207X00000X
MI5101022024207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery