Healthcare Provider Details

I. General information

NPI: 1518136282
Provider Name (Legal Business Name): HOFFMANN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S DIVISION ST
WAUPACA WI
54981-1582
US

IV. Provider business mailing address

199 S DIVISION ST
WAUPACA WI
54981-1582
US

V. Phone/Fax

Practice location:
  • Phone: 715-942-2154
  • Fax: 715-942-2156
Mailing address:
  • Phone: 715-942-2154
  • Fax: 715-942-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number26569
License Number StateWI

VIII. Authorized Official

Name: DR. JOHN GREGORY HOFFMANN
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 715-942-2154