Basic Information
Provider Information
NPI: 1386636306
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARANGO
FirstName: ANGELA
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 650 JOEL DR
Address2:  
City: FORT CAMPBELL
State: KY
PostalCode: 422235318
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 650 JOEL DR
Address2:  
City: FORT CAMPBELL
State: KY
PostalCode: 422235318
CountryCode: US
TelephoneNumber: 2707988727
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/16/2005
LastUpdateDate: 10/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA83036CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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