Provider Demographics
NPI:1740462803
Name:ANEL-TIANGCO, RAQUEL DE LEON (MD)
Entity type:Individual
Prefix:
First Name:RAQUEL DE LEON
Middle Name:
Last Name:ANEL-TIANGCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAQUEL MARGUERITE
Other - Middle Name:DE LEON
Other - Last Name:ANEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1315 S. CLIFF AVE.
Practice Address - Street 2:STE. 3000
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1061
Practice Address - Country:US
Practice Address - Phone:605-322-7600
Practice Address - Fax:605-322-7601
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435941207R00000X
SD8278207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002098747OtherHIGHMARK BLUE SHIELD
PA1023034030002Medicaid
PA1023034030001Medicaid
SD6007450Medicaid
002098747OtherHIGHMARK BLUE SHIELD
SD6007450Medicaid