Provider Demographics
NPI:1013999853
Name:HUFFMAN, BRYAN W (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:W
Last Name:HUFFMAN
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 1:2025 VAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6904
Mailing Address - Country:US
Mailing Address - Phone:616-772-2020
Mailing Address - Fax:616-396-5380
Practice Address - Street 1:2025 VAN HILL DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-6904
Practice Address - Country:US
Practice Address - Phone:616-772-2020
Practice Address - Fax:616-396-5380
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078193207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4736618Medicaid
MIBH078193OtherBCBSM
MIBH078193OtherBCBSM
MI4736618Medicaid
MII29432Medicare UPIN