Healthcare Provider Details

I. General information

NPI: 1013080894
Provider Name (Legal Business Name): MICHAEL HERBERT HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 CUSTER ST SUITE D
MANITOWOC WI
54220-4324
US

IV. Provider business mailing address

3415 CUSTER ST SUITE D
MANITOWOC WI
54220-4324
US

V. Phone/Fax

Practice location:
  • Phone: 920-652-9310
  • Fax:
Mailing address:
  • Phone: 920-652-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37805
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: