Provider Demographics
NPI:1386683217
Name:ENDERS, ANGELA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:ENDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M273
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-0180
Mailing Address - Fax:269-381-7347
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M273
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-0180
Practice Address - Fax:269-381-7347
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004064363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
383148262OtherEIN-HEALTHCARE MIDWEST
MI0N83160001Medicare ID - Type Unspecified
MIP00030381Medicare PIN
383148262OtherEIN-HEALTHCARE MIDWEST
MICA3050Medicare PIN