Healthcare Provider Details

I. General information

NPI: 1134119886
Provider Name (Legal Business Name): JOHN HOPKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD STE 200
KALAMAZOO MI
49048
US

IV. Provider business mailing address

1535 GULL RD STE 200
KALAMAZOO MI
49048-1638
US

V. Phone/Fax

Practice location:
  • Phone: 269-388-6350
  • Fax: 269-388-4738
Mailing address:
  • Phone: 269-388-6350
  • Fax: 269-388-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036110695
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301091431
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: