Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 5101008395 | MI |
N | 2086S0102X | Surgical Critical Care | CL0065 | NV |
NPI | 1164594420 |
---|---|
Provider Name | Dr. James E Hoogeboom |
First Address | Grand Rapids, MI 49546-6775 |
Second Address | Grand Rapids, MI 49546-6775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 25/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3346752 | (05) | MI |
E56082 | (02) |