Basic Information
| Provider Information | |||||||||
| NPI: | 1134361033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAFF | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 N 120TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494242196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163965855 | ||||||||
| FaxNumber: | 6163965720 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 N 120TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494242196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163965855 | ||||||||
| FaxNumber: | 6163965720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2007016466 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 5101020211 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1134361033 | 05 | MI | MEDICAID |