Provider Demographics
NPI:1003822743
Name:HUIZENGA, AARON DALE (DO)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DALE
Last Name:HUIZENGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-1409
Mailing Address - Country:US
Mailing Address - Phone:315-686-2094
Mailing Address - Fax:315-686-2821
Practice Address - Street 1:909 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-1409
Practice Address - Country:US
Practice Address - Phone:315-686-2094
Practice Address - Fax:315-686-2821
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03477034Medicaid
I57974Medicare UPIN
M32670044Medicare ID - Type UnspecifiedPARTICIPATING
MI39950OtherHEALTH PLAN OF MICHIGAN
MI114915065Medicaid
I57974Medicare UPIN