Healthcare Provider Details

I. General information

NPI: 1932198447
Provider Name (Legal Business Name): RONALD M HOFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 ALGER ST SE
GRAND RAPIDS MI
49507-3530
US

IV. Provider business mailing address

733 ALGER ST SE
GRAND RAPIDS MI
49507-3530
US

V. Phone/Fax

Practice location:
  • Phone: 616-243-9515
  • Fax: 616-243-1815
Mailing address:
  • Phone: 616-243-9515
  • Fax: 616-243-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301047171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: