Provider Demographics
NPI:1154356962
Name:IACOBELLI, ANGELA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:IACOBELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:43417 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1961
Mailing Address - Country:US
Mailing Address - Phone:586-981-0390
Mailing Address - Fax:586-803-3512
Practice Address - Street 1:43417 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1961
Practice Address - Country:US
Practice Address - Phone:586-981-0390
Practice Address - Fax:586-803-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301406807207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF63498Medicare UPIN