Provider Demographics
NPI:1801974050
Name:HOGAN, FREDERICK A (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E JOLLY RD
Mailing Address - Street 2:SUITE 12 C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6817
Mailing Address - Country:US
Mailing Address - Phone:517-882-3900
Mailing Address - Fax:517-882-5060
Practice Address - Street 1:609 E JOLLY RD
Practice Address - Street 2:SUITE 12 C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6817
Practice Address - Country:US
Practice Address - Phone:517-882-3900
Practice Address - Fax:517-882-5060
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E01007OtherBCBSM
0E01007OtherBCBSM