Individual
DR. MICHAEL THEODORE BANGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 244-0411
Mailing address
11303 LUCKY DAN DR, NOBLESVILLE, IN 46060-4774
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01079385B
IN
207L00000X
Anesthesiology Physician
35.123521
OH
207L00000X
Anesthesiology Physician
ME141243
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105961
—
OH
01
—
Q00288108
RAILROAD MEDICARE
IN
Enumeration date
05/10/2010
Last updated
02/02/2023
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