Provider Demographics
NPI:1164422218
Name:HOP, JON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:HOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2196
Mailing Address - Country:US
Mailing Address - Phone:616-396-5855
Mailing Address - Fax:616-396-5720
Practice Address - Street 1:370 120TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-396-5855
Practice Address - Fax:616-396-5720
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072024207XS0114X
MIJH072024207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP94459OtherBLUE CARE NETWORK
MI3474897Medicaid
MIJH072024OtherSTATE LICENSE
MI5637634OtherAETNA
MI5637634OtherAETNA
MI0G06055009Medicare PIN