Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036069741 | IL |
N | 208000000X | Pediatrician | 036069741 | IL |
NPI | 1427026897 |
---|---|
Provider Name | Brad Angle |
First Address | Park Ridge, IL 60068-1157 |
Second Address | Park Ridge, IL 60068-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036069741 | (05) | IL |
F85128 | (02) |