Provider Demographics
NPI:1295797942
Name:HOFFMANN, TIMOTHY D (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:SUITE 2805
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:906-643-8689
Mailing Address - Fax:906-643-6716
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:SUITE 2805
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-8689
Practice Address - Fax:906-643-6716
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4640910Medicaid
MI4640929Medicaid
MI4640929Medicaid
A36090025Medicare ID - Type Unspecified