Healthcare Provider Details

I. General information

NPI: 1295797942
Provider Name (Legal Business Name): TIMOTHY D HOFFMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N STATE ST SUITE 2805
SAINT IGNACE MI
49781-1048
US

IV. Provider business mailing address

1140 N STATE ST SUITE 2805
SAINT IGNACE MI
49781-1048
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-8689
  • Fax: 906-643-6716
Mailing address:
  • Phone: 906-643-8689
  • Fax: 906-643-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301066594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: