Individual
ANGELA K IANITELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
16151 19 MILE RD STE 215, CLINTON TOWNSHIP, MI 48038-1157
(586) 263-2300
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004740
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00725248
RAILROAD MEDICARE
MI
01
—
STATE LISC.
5601004740
MI
Enumeration date
01/02/2007
Last updated
07/18/2023
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