Provider Demographics
NPI:1710051867
Name:MARC A HOESEMA MD PC
Entity Type:Organization
Organization Name:MARC A HOESEMA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOEKSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-252-7200
Mailing Address - Street 1:1919 BOSTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4160
Mailing Address - Country:US
Mailing Address - Phone:616-252-7200
Mailing Address - Fax:
Practice Address - Street 1:1919 BOSTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4160
Practice Address - Country:US
Practice Address - Phone:616-252-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARC A HOEKSEMA MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079863208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P13120Medicare PIN
MI0P13120Medicare Oscar/Certification