Provider Demographics
NPI:1699876284
Name:HOOGTERP, ANGELA A (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:HOOGTERP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-672-6336
Practice Address - Fax:231-672-6335
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010103032084P0800X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN27530089OtherMEDICARE PTAN
MI2653349394OtherBCBS OF MI
MI2653349394OtherBCBS OF MI
MIN27530089OtherMEDICARE PTAN