Provider Demographics
NPI:1427243153
Name:STROUP, ALENE R (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALENE
Middle Name:R
Last Name:STROUP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:020
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-381-4577
Mailing Address - Fax:269-381-6409
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:020
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-381-4577
Practice Address - Fax:269-381-6409
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N33470Medicare PIN