Healthcare Provider Details

I. General information

NPI: 1013999853
Provider Name (Legal Business Name): BRYAN W HUFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 VAN HILL DR
ZEELAND MI
49464-6904
US

IV. Provider business mailing address

2025 VAN HILL DR
ZEELAND MI
49464-6904
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-2020
  • Fax: 616-396-5380
Mailing address:
  • Phone: 616-772-2020
  • Fax: 616-396-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301078193
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: