Healthcare Provider Details

I. General information

NPI: 1609062967
Provider Name (Legal Business Name): MICHAEL ROBERT HOJNACKI AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 147
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-1176
  • Fax:
Mailing address:
  • Phone: 616-391-2862
  • Fax: 616-391-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001247
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000573
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: