Provider Demographics
NPI:1013976638
Name:ANGELIQUE BARRETO M.D., P.C.
Entity type:Organization
Organization Name:ANGELIQUE BARRETO M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-286-1075
Mailing Address - Street 1:3418 NW 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4009
Mailing Address - Country:US
Mailing Address - Phone:405-286-1075
Mailing Address - Fax:405-608-1075
Practice Address - Street 1:3418 NW 135TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4009
Practice Address - Country:US
Practice Address - Phone:405-286-1075
Practice Address - Fax:405-608-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522531Medicare ID - Type UnspecifiedMEDICARE GROUP NO. MDPC