Healthcare Provider Details

I. General information

NPI: 1649429630
Provider Name (Legal Business Name): ANGELA MARIE STURDIVANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BARCLAY AVE NE SUITE 304
GRAND RAPIDS MI
49503-2556
US

IV. Provider business mailing address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-2160
  • Fax: 616-391-0697
Mailing address:
  • Phone: 914-831-6800
  • Fax: 914-831-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number249087
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301108507
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number249087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: