Doctor Name: | ANGELA P LASALLE |
NPI Number: | 1588621619 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 01047101 |
Business Practice Address: | 11141 Parkview Plaza Dr Suite 210 Fort Wayne, IN - 468451713 |
Business Phone Number: | 2606726590 |
Business Fax Number: | 2606726599 |
Mailing Address: | 11141 Parkview Plaza Dr, Suite 210 FORT WAYNE |
State: | IN |
Postal Code: | 468451713 |
Phone Number: | 2606726590 |
Fax Number: | 2606726599 |
NPI Enumeration Date: | 05/01/2006 |
NPI Last Update Date: | 02/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 01047101 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |