Provider Demographics
NPI:1629074448
Name:HORNBACH, ERICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:
Last Name:HORNBACH
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 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-6100
Mailing Address - Fax:517-884-6233
Practice Address - Street 1:4660 S HAGADORN RD STE 420
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5353
Practice Address - Country:US
Practice Address - Phone:517-884-6100
Practice Address - Fax:517-884-6233
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077519207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0330637OtherBLUECARE NETWORK
MI2003306372OtherBLUE CROSS/BLUE SHIELD
MI4290858Medicaid
MI200000001119OtherPHYSICIANS HEALTH PLAN
MI0330637OtherBLUECARE NETWORK
MI200000001119OtherPHYSICIANS HEALTH PLAN