Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301406807 | MI |
NPI | 1154356962 |
---|---|
Provider Name | Dr. Angela M Iacobelli |
First Address | Sterling Heights, MI 48313-1961 |
Second Address | Sterling Heights, MI 48313-1961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F63498 | (02) | MI |