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1497544274 NPI number — OLIVIA HOCK CROFOOT

NPI Number: 1497544274
Health Care Provider/Practitioner: OLIVIA HOCK CROFOOT

Information about “1497544274” NPI (OLIVIA HOCK CROFOOT) exists in 1497544274 in HTML format HTML  |  1497544274 in plain Text format TXT  |  1497544274 in PDF (Portable Document Format) PDF  |  1497544274 in an XML format XML  formats.

NPI Number : 1497544274 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497544274",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CROFOOT",
    "FirstName": "OLIVIA",
    "MiddleName": "HOCK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3245 HEALTH DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRANGER",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46530-1380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-552-2830",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "420 W HIGH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOWAGIAC",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49047-1943",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-783-3052",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/06/2025",
    "LastUpdateDate": "10/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "5601013081",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "5601013081",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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