Provider Demographics
NPI:1700088333
Name:KARL, ANGELA R (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:KARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7938 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-436-8583
Practice Address - Fax:260-432-8748
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01065197A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9360077OtherAETNA
IN000000680197OtherANTHEM
IN200909910Medicaid
9360077OtherAETNA
INM400028153Medicare PIN
IN01065197AOtherLICENSE