Healthcare Provider Details

I. General information

NPI: 1740645795
Provider Name (Legal Business Name): KEITH R HOFFMANN MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25915 HARPER AVE SUITE B
SAINT CLAIR SHORES MI
48081-3770
US

IV. Provider business mailing address

25915 HARPER AVE SUITE B
SAINT CLAIR SHORES MI
48081-3770
US

V. Phone/Fax

Practice location:
  • Phone: 586-872-2580
  • Fax: 586-872-2689
Mailing address:
  • Phone: 586-872-2580
  • Fax: 586-872-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH R HOFFMANN
Title or Position: PRESIDENT
Credential: MD
Phone: 586-872-2580