Healthcare Provider Details

I. General information

NPI: 1467846006
Provider Name (Legal Business Name): MAREK HANSDORFER MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W FRONT ST
TRAVERSE CITY MI
49684-2287
US

IV. Provider business mailing address

701 W FRONT ST
TRAVERSE CITY MI
49684-2287
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-0800
  • Fax: 231-935-0808
Mailing address:
  • Phone: 231-935-0800
  • Fax: 231-935-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberBP10087150
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number4301514490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: