Healthcare Provider Details

I. General information

NPI: 1508870197
Provider Name (Legal Business Name): AMY LYNN HOFFMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 SHELDON RD
GRAND HAVEN MI
49417-2404
US

IV. Provider business mailing address

PO BOX 673755
DETROIT MI
48267-3755
US

V. Phone/Fax

Practice location:
  • Phone: 866-898-7139
  • Fax: 616-975-9824
Mailing address:
  • Phone: 866-898-7139
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberO2823
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02003951A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101014274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: