Provider Demographics
NPI:1811171234
Name:CHRISTOPHER R DEANGELIS D.O
Entity type:Organization
Organization Name:CHRISTOPHER R DEANGELIS D.O
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-676-3373
Mailing Address - Street 1:25000 HALL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5112
Mailing Address - Country:US
Mailing Address - Phone:734-676-3373
Mailing Address - Fax:734-675-1678
Practice Address - Street 1:25000 HALL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5112
Practice Address - Country:US
Practice Address - Phone:734-676-3373
Practice Address - Fax:734-675-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD013396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5390707OtherAETNA
MIP127746OtherCARE CHOICES
MI1158206834OtherBCBS
MI5820683OtherBCN
MIC8111OtherM CARE
MI110218318OtherRAILROAD MEDICARE
MIP127746OtherCARE CHOICES