Provider Demographics
NPI:1568491397
Name:HUFF, DAVID A (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HUFF
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 1:9900 W M 21 STE 104
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:MI
Mailing Address - Zip Code:48866-9798
Mailing Address - Country:US
Mailing Address - Phone:989-862-4224
Mailing Address - Fax:989-862-4382
Practice Address - Street 1:9900 W M 21 STE 104
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9798
Practice Address - Country:US
Practice Address - Phone:989-862-4224
Practice Address - Fax:989-862-4382
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568491397Medicaid
MIN53550013Medicare PIN
MI1568491397Medicaid