Provider Demographics
NPI:1982642005
Name:ANGELILLI, MARY LU (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LU
Last Name:ANGELILLI
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3950 BEAUBIEN - 1ST FL
Practice Address - Street 2:CHILDRENS HOSPITAL MI AMBULATORY PEDS (2ND FLOOR)
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-832-8290
Practice Address - Fax:313-993-0081
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-01-20
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Provider Licenses
StateLicense IDTaxonomies
MI4301044538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics