Provider Demographics
NPI:1215183892
Name:HOLZGEN, SARA STAUPE (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:STAUPE
Last Name:HOLZGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:STAUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
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:231-672-2120
Mailing Address - Fax:313-432-7758
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-727-7939
Practice Address - Fax:231-727-7935
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4160008OtherMEDICARE GROUP PTAN