Provider Demographics
NPI:1679817761
Name:ANGELA STOUTENBURG - ALAOUIE LLC
Entity Type:Organization
Organization Name:ANGELA STOUTENBURG - ALAOUIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUTENBURG - ALAOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-648-6170
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-6170
Mailing Address - Fax:
Practice Address - Street 1:120 N DELAWARE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1009
Practice Address - Country:US
Practice Address - Phone:810-648-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002214213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty