Healthcare Provider Details

I. General information

NPI: 1659098200
Provider Name (Legal Business Name): EVAN HOFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD
FARMINGTON HILLS MI
48334-5310
US

IV. Provider business mailing address

27777 INKSTER RD
FARMINGTON HILLS MI
48334-5310
US

V. Phone/Fax

Practice location:
  • Phone: 248-238-8126
  • Fax:
Mailing address:
  • Phone: 248-238-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: