Healthcare Provider Details

I. General information

NPI: 1407083041
Provider Name (Legal Business Name): MATTHEW JOSEPH HORNIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

IV. Provider business mailing address

13699 E OLD US HIGHWAY 12
CHELSEA MI
48118-9664
US

V. Phone/Fax

Practice location:
  • Phone: 734-475-4507
  • Fax:
Mailing address:
  • Phone: 734-475-4500
  • Fax: 734-475-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101018382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: