Healthcare Provider Details

I. General information

NPI: 1710541404
Provider Name (Legal Business Name): MICHAEL KENNETH HOFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HEALTH DR SW STE 200
WYOMING MI
49519-9691
US

IV. Provider business mailing address

2128 CHESANING DR SE
GRAND RAPIDS MI
49506-5311
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-3158
  • Fax: 616-819-2222
Mailing address:
  • Phone: 616-581-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301510242
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301510242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: