Provider Demographics
NPI:1982738621
Name:ANGELI, DANIEL E (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:ANGELI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PINE GROVE AVE
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3511
Mailing Address - Country:US
Mailing Address - Phone:810-987-5000
Mailing Address - Fax:810-985-2675
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-989-3300
Practice Address - Fax:810-985-2675
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5191010207207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE49497Medicare UPIN
MIP40540077Medicare PIN
MIQ26294420Medicare PIN
MIN87430070Medicare PIN