Healthcare Provider Details

I. General information

NPI: 1063545226
Provider Name (Legal Business Name): PATRICIA SUE HOEPNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA SUE BUCK MD

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N PATTERSON RD
REED CITY MI
49677-8041
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-832-7170
  • Fax: 231-932-9554
Mailing address:
  • Phone: 616-486-6790
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME71781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: