Provider Demographics
NPI:1790847614
Name:AGEE, ANGELO K (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:K
Last Name:AGEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TAYLOR ROAD STE 200
Mailing Address - Street 2:PO BOX 240216
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0216
Mailing Address - Country:US
Mailing Address - Phone:334-271-3100
Mailing Address - Fax:334-271-4669
Practice Address - Street 1:300 TAYLOR ROAD STE 200
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36124
Practice Address - Country:US
Practice Address - Phone:334-271-3100
Practice Address - Fax:334-271-4669
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00091213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070847OtherBC BS
T68857Medicare UPIN