Individual
KENNETH DEANGELIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 169TH ST, HAMMOND, IN 46323-2068
(989) 903-5267
(219) 989-2558
Mailing address
400 N LAKE PARK AVE APT T2N, HOBART, IN 46342-3031
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002052A
IN
Other
Enumeration date
12/01/2014
Last updated
12/01/2014
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