Provider Demographics
NPI:1164594420
Name:HOOGEBOOM, JAMES E (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:HOOGEBOOM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6290 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6775
Mailing Address - Country:US
Mailing Address - Phone:616-975-7768
Mailing Address - Fax:616-975-7769
Practice Address - Street 1:6290 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6775
Practice Address - Country:US
Practice Address - Phone:616-975-7768
Practice Address - Fax:616-975-7769
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCL00652086S0102X
MI51010083952086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3346752Medicaid
0D16150Medicare PIN
E56082Medicare UPIN