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1396853966

NPI Code Detail

MEDICARE: DR. GINA CHARLENE ANG MD

MEDICARE: DR. GINA CHARLENE ANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	5601093226	MI
2	207ND0101X	MOHS-Micrographic Surgery Physician	5601093226	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0D16223	OTHER	MI	MEDICARE GROUP
3	CI2832	OTHER	MI	MEDICARE RAILROAD GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070D16223	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1396853966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA CHARLENE ANG MD

Provider Business Mailing Address
First Line	:	3434 RIVERTOWN POINT CT SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-3076
Country	:	US
Telephone Number	:	616-257-3344
Fax Number	:	616-257-1491

Provider Business Practice Location Address
First Line	:	3434 RIVERTOWN POINT CT SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-3076
Country	:	US
Telephone Number	:	616-257-3344
Fax Number	:	616-257-1491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/31/2024

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1528085040 — MR. RONALD W REUSCH PA C
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1407941396 — MR. KURT VANDERVEEN PA-C
Practice Location Address:

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Directions to “ DR. GINA CHARLENE ANG MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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