Provider Demographics
NPI:1063518785
Name:HOEKSTRA, LISA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4312
Mailing Address - Country:US
Mailing Address - Phone:616-249-0159
Mailing Address - Fax:833-393-6789
Practice Address - Street 1:311 STATE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4312
Practice Address - Country:US
Practice Address - Phone:616-249-0159
Practice Address - Fax:333-936-7898
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILH062137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063518785Medicaid
MI1063518785Medicaid
MI383694376OtherTAX ID
MI383694376OtherTAX ID
MI1063518785Medicaid