Healthcare Provider Details

I. General information

NPI: 1134162423
Provider Name (Legal Business Name): LAWRENCE D HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 ORCHARD LAKE RD SUITE 200
FARMINGTON HILLS MI
48336-2560
US

IV. Provider business mailing address

23800 ORCHARD LAKE RD SUITE 200
FARMINGTON HILLS MI
48336-2560
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301025278
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: