Healthcare Provider Details

I. General information

NPI: 1326756537
Provider Name (Legal Business Name): DANIEL HOFFMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN HOFFMANN

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 310
GRAND RAPIDS MI
49525-9350
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE STE 310
GRAND RAPIDS MI
49525-9350
US

V. Phone/Fax

Practice location:
  • Phone: 616-279-6414
  • Fax: 616-591-3393
Mailing address:
  • Phone: 616-279-6414
  • Fax: 616-591-3393

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: