Angelos, Brock Randall
Angelos, Brock Randall is an individual health care provider with primary practice located at 4213 O St , Lincoln NE 68510-1751. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Angelos, Brock Randall can be contacted via phone (402) 488-8114.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 194 | Nebraska |
Profile Details
| NPI number | 1508978693 |
|---|---|
| LBN Legal business name | Angelos, Brock Randall |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508978693 | NPPES |
| Other | 02593 | BCBS | |
| MEDICAID | 47070731200 | BCBS |
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