Provider Demographics
NPI:1144326109
Name:MIELE, ANGELO (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:MIELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2793
Mailing Address - Country:US
Mailing Address - Phone:630-668-3210
Mailing Address - Fax:630-668-3505
Practice Address - Street 1:501 THORNHILL DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2793
Practice Address - Country:US
Practice Address - Phone:630-668-3210
Practice Address - Fax:630-668-3505
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE GROUP PTAN
IL036064705Medicaid
ILP01328176OtherMEDICARE INDIVIDUAL RR PTAN
ILF400137214OtherMEDICARE INDIVIDUAL PTAN
ILCA4748OtherMEDICARE GROUP RR PTAN
ILF400137214OtherMEDICARE INDIVIDUAL PTAN
IL036064705Medicaid