Provider Demographics
NPI:1396853966
Name:ANG, GINA CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:CHARLENE
Last Name:ANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 RIVERTOWN POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3076
Mailing Address - Country:US
Mailing Address - Phone:616-257-3344
Mailing Address - Fax:616-257-1491
Practice Address - Street 1:3434 RIVERTOWN POINT CT SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3076
Practice Address - Country:US
Practice Address - Phone:616-257-3344
Practice Address - Fax:616-257-1491
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601093226207N00000X, 207ND0101X
PAMD432194207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16223OtherMEDICARE GROUP
MI070D16223OtherBCBS OF MICHIGAN
MICI2832OtherMEDICARE RAILROAD GROUP
MICI2832OtherMEDICARE RAILROAD GROUP
PA102026143Medicaid
I59381Medicare UPIN