Provider Demographics
NPI:1063401594
Name:HOOPINGARNER, BRADLEY R (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:HOOPINGARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:804 SERVICE RD # A110
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-353-3003
Practice Address - Fax:517-353-5514
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232756208000000X
MI4301074387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA277534OtherBLUE CROSS
MI1063401594Medicaid
VA6735983Medicaid
VA277534OtherBLUE CROSS
VA6735983Medicaid