Provider Demographics
NPI:1609593029
Name:HOFER, JOSEPH ALAN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:HOFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5693 N TERRITORIAL RD E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9323
Mailing Address - Country:US
Mailing Address - Phone:734-596-8327
Mailing Address - Fax:
Practice Address - Street 1:3917 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2229
Practice Address - Country:US
Practice Address - Phone:800-366-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-1359084Medicaid