Provider Demographics
NPI:1972042562
Name:STOECKER, ANDREA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:STOECKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 RED DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4729
Mailing Address - Country:US
Mailing Address - Phone:231-333-1331
Mailing Address - Fax:231-259-1001
Practice Address - Street 1:818 RED DR STE 100
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4729
Practice Address - Country:US
Practice Address - Phone:231-333-1331
Practice Address - Fax:231-259-1001
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine