Healthcare Provider Details

I. General information

NPI: 1598751968
Provider Name (Legal Business Name): JOHN F. HILDEBRANDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LOVELL ST
IONIA MI
48846-9706
US

IV. Provider business mailing address

2687 W LINCOLN AVE
IONIA MI
48846-9592
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-5732
  • Fax: 616-527-5720
Mailing address:
  • Phone: 616-527-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301G7296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: