Healthcare Provider Details

I. General information

NPI: 1710854310
Provider Name (Legal Business Name): ELIJAH HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

17 MANZANA CT NW APT 3B
GRAND RAPIDS MI
49534-5775
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-4647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: