Provider Demographics
NPI:1225998123
Name:HILGENDORF, COLIN CHARLES
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:CHARLES
Last Name:HILGENDORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71499 KLINE RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-9751
Mailing Address - Country:US
Mailing Address - Phone:574-298-8787
Mailing Address - Fax:
Practice Address - Street 1:333 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3300
Practice Address - Country:US
Practice Address - Phone:616-331-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer