Provider Demographics
NPI:1992819767
Name:ANGELILLO, MICHAEL P (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:ANGELILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3880 COCONUT CREEK PKWY
Mailing Address - Street 2:#100
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066
Mailing Address - Country:US
Mailing Address - Phone:954-973-9666
Mailing Address - Fax:954-978-6625
Practice Address - Street 1:3880 COCONUT CREEK PKWY
Practice Address - Street 2:#100
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066
Practice Address - Country:US
Practice Address - Phone:954-973-9666
Practice Address - Fax:954-978-6625
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME54174207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
08357OtherBC
FL08357UMedicare ID - Type Unspecified
08357OtherBC