Provider Demographics
NPI:1427057389
Name:HOFF, KENNETH EUGENE (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EUGENE
Last Name:HOFF
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 1:700 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-1506
Mailing Address - Country:US
Mailing Address - Phone:574-223-4337
Mailing Address - Fax:574-223-4375
Practice Address - Street 1:1300 EAST 9TH ST.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1506
Practice Address - Country:US
Practice Address - Phone:574-223-2020
Practice Address - Fax:574-224-5847
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024912A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100118310Medicaid
IN270480Medicare ID - Type Unspecified
IN100118310Medicaid