Provider Demographics
NPI:1649596800
Name:HOTALING, JEFFREY MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MORRIS
Last Name:HOTALING
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:STE 400 - CREDENTIALING DEPT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1135
Mailing Address - Country:US
Mailing Address - Phone:248-581-5973
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:26400 W 12 MILE RD STE 111
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1771
Practice Address - Country:US
Practice Address - Phone:248-357-4151
Practice Address - Fax:248-357-0229
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301113636207Y00000X
PAMD454807207Y00000X
LA303189207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology