Healthcare Provider Details

I. General information

NPI: 1841391448
Provider Name (Legal Business Name): ANGELA HOOGTERP, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E GRAND RIVER AVE
EAST LANSING MI
48823-6732
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-1774
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101010303
License Number StateMI

VIII. Authorized Official

Name: ANGELA A HOOGTERP
Title or Position: OWNER
Credential: DO
Phone: 517-337-1774