Provider Demographics
NPI:1306812854
Name:HOFFMAN, JENNIFER THOME (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THOME
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:THOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4277 OKEMOS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3282
Mailing Address - Country:US
Mailing Address - Phone:517-816-8723
Mailing Address - Fax:517-247-3558
Practice Address - Street 1:4277 OKEMOS RD STE 100
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3282
Practice Address - Country:US
Practice Address - Phone:517-816-8723
Practice Address - Fax:517-247-3558
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010873972083A0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54476Medicare UPIN