Healthcare Provider Details

I. General information

NPI: 1225998123
Provider Name (Legal Business Name): COLIN CHARLES HILGENDORF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MICHIGAN ST NE
GRAND RAPIDS MI
49503-3300
US

IV. Provider business mailing address

71499 KLINE RD
NILES MI
49120-9751
US

V. Phone/Fax

Practice location:
  • Phone: 616-331-5000
  • Fax:
Mailing address:
  • Phone: 574-298-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: