Provider Demographics
NPI:1831198795
Name:HOFFMAN, THOMAS MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARVIN
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 S M 37 HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-9676
Mailing Address - Country:US
Mailing Address - Phone:269-945-3401
Mailing Address - Fax:269-945-2760
Practice Address - Street 1:1005 W GREEN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1712
Practice Address - Country:US
Practice Address - Phone:269-945-3401
Practice Address - Fax:269-945-2760
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH406804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1986644Medicaid
MI0080049Medicare ID - Type Unspecified
MI1986644Medicaid