Provider Demographics
NPI:1023009453
Name:HOOD, BRIAN S (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:HOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 W. OAK ST.
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1597
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:231-924-4064
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012329207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH00559Medicare UPIN
MI0M72050006Medicare ID - Type Unspecified
MIC7753OtherMCARE
MI4211012Medicaid
MI128817OtherCARE CHCS/PREFERRED CHCS
MI76900137OtherAETNA
MI4198233 TYPE 11Medicaid
MI2056307075OtherBCBSM PIN
MI4211012 TYPE 11Medicaid
MI0F26007Medicare PIN