Basic Information
| Provider Information | |||||||||
| NPI: | 1770577504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANGELIS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | ME 78250 | FL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | ME 78250 | FL | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.