Provider Demographics
NPI:1811428964
Name:CILIBERTI, ANGELO ANTHONY JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:ANTHONY
Last Name:CILIBERTI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3991 DUTCHMANS LN STE 208
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4723
Mailing Address - Country:US
Mailing Address - Phone:502-899-6061
Mailing Address - Fax:502-899-6127
Practice Address - Street 1:3991 DUTCHMANS LN STE 208
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-6061
Practice Address - Fax:502-899-6127
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56690207RR0500X
IL036.151848207R00000X, 207RR0500X
IL125.070055207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program