Provider Demographics
NPI:1548210628
Name:HALIBURDA, ANGELA (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:HALIBURDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 CAVIL WAY
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3772
Mailing Address - Country:US
Mailing Address - Phone:920-351-0289
Mailing Address - Fax:
Practice Address - Street 1:1260 32ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1649
Practice Address - Country:US
Practice Address - Phone:320-230-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48462207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43517300Medicaid
WI43517300Medicaid