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General NPI Number Information
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NPI Number | 1518136282
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Entity Type | Organization
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Legal Business Name | HOFFMANN CLINIC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 199 S DIVISION ST
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City | WAUPACA
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State | WI
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Zip | 54981-1582
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Country | US
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Telephone | 715-942-2154
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Fax | 715-942-2156
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Provider Business Mailing Address
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Address Line | 199 S DIVISION ST
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City | WAUPACA
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State | WI
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Zip | 54981-1582
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Country | US
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Telephone | 715-942-2154
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Fax | 715-942-2156
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. JOHN GREGORY HOFFMANN
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Credential | M.D.
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Telephone | 715-942-2154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 26569
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License Number State | WI
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