Individual provider Active NPI

Angelina Antonyan Porter, DO

  • Family Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1104612845
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5151017229 Issued in MI
Practice address
44250 Dequindre Rd
Sterling Heights, MI 48314-1002
Phone
(248) 964-0400
NPI assigned
Apr 18, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 5151017229 MI Primary

Addresses

Primary practice location

44250 Dequindre Rd
Sterling Heights, MI 48314-1002

Mailing address

44250 Dequindre Rd
Sterling Heights, MI 48314-1002
Phone (248) 964-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250429003082 MI Order and Referring Only - Family PracticePractitioner - Family Practice 1658897913

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5151017229MIMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1104612845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44250 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141002",
            "telephone_number": "248-964-0400",
            "fax_number": "248-964-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44250 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141002",
            "telephone_number": "248-964-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "ANGELINA",
        "middle_name": "ANTONYAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-18",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5151017229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

Verify at the official NPI Registry.