Provider Demographics
NPI:1154307098
Name:OOSTERHOUSE, GENE L (DPM)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:L
Last Name:OOSTERHOUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7903
Mailing Address - Country:US
Mailing Address - Phone:616-457-7171
Mailing Address - Fax:616-457-2112
Practice Address - Street 1:669 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7903
Practice Address - Country:US
Practice Address - Phone:616-457-7171
Practice Address - Fax:616-457-1121
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001534213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3040411Medicaid
GO001534OtherBCBS
480009518OtherRR MEDICARE
U23388Medicare UPIN
MI3040411Medicaid
0307890001Medicare NSC