Provider Demographics
NPI:1174812564
Name:LLANIO, ANGEL ENRIQUE (DO)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:ENRIQUE
Last Name:LLANIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:606 4TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5226
Practice Address - Country:US
Practice Address - Phone:941-722-7785
Practice Address - Fax:941-729-5267
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11980207Q00000X
FLUO2388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011672000Medicaid
FLHH163XMedicare PIN