Basic Information
| Provider Information | |||||||||
| NPI: | 1609219690 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERNADETTE ANGELES MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21723 GARRISON ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135955215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42450 W 12 MILE RD | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483773013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485134100 | ||||||||
| FaxNumber: | 2485134105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | ANGELES | ||||||||
| AuthorizedOfficialFirstName: | BERNADETTE | ||||||||
| AuthorizedOfficialMiddleName: | LOURDES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3135955215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301074466 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.