Provider Demographics
NPI:1669478582
Name:FOLSTAD, ANGELA J (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:FOLSTAD
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 1:2115 S FREMONT AVE STE 2900
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2233
Mailing Address - Country:US
Mailing Address - Phone:417-820-3535
Mailing Address - Fax:
Practice Address - Street 1:2115 S FREMONT AVE STE 2900
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2233
Practice Address - Country:US
Practice Address - Phone:417-820-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58031208000000X
SD8116208000000X
MO2022033678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94569Medicare UPIN