Healthcare Provider Details

I. General information

NPI: 1861564205
Provider Name (Legal Business Name): MARC A HOEKSEMA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BURTON ST SE
GRAND RAPIDS MI
49506-4670
US

IV. Provider business mailing address

PO BOX 2370
GRAND RAPIDS MI
49501
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-1045
  • Fax: 616-301-1260
Mailing address:
  • Phone: 616-301-1045
  • Fax: 616-301-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301079863
License Number StateMI

VIII. Authorized Official

Name: MARC A HOEKSEMA
Title or Position: PRESIDENT
Credential: MD
Phone: 616-301-1045