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General NPI Number Information
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NPI Number | 1225998123
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Entity Type | Individual
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Provider Name | COLIN CHARLES HILGENDORF
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 333 MICHIGAN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3300
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Country | US
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Telephone | 616-331-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 71499 KLINE RD
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City | NILES
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State | MI
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Zip | 49120-9751
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Country | US
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Telephone | 574-298-8787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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