Provider Demographics
NPI:1669559050
Name:CAPRICCHIONE, ANGELO MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:MICHAEL
Last Name:CAPRICCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NORTH 12 STREET EAST
Mailing Address - Street 2:SUITE F
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-857-6422
Mailing Address - Fax:307-857-5788
Practice Address - Street 1:98 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1758
Practice Address - Country:US
Practice Address - Phone:208-785-3865
Practice Address - Fax:208-785-3504
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11048207R00000X
IDM-11048207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9990Medicare ID - Type Unspecified
I01504Medicare UPIN