Basic Information
| Provider Information | |||||||||
| NPI: | 1689693384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOEKSTRA | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693822500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693822500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036112369 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 4301093662 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 336-076268 | 01 | IL | CONTROLLED SUBSTANCE | OTHER | 390003 | 01 | MI | BCBSM | OTHER | BH9668495 | 01 | DEA | OTHER | 1689693384 | 05 | MI | MEDICAID |