MEDICARE: DRS. HOFFMAN, BIRMINGHAM & ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK3646	OTHER	OH	MEDICARE RR GROUP PIN
3	CK3646	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000024792	OTHER	OH	BCBS GROUP #

General Provider Information

NPI Number	:	1306864749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. HOFFMAN, BIRMINGHAM & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1108
Second Line	:	ATTN: BARB SIMMONS
City	:	ANN ARBOR
State	:	MI
Zip	:	48106-1108
Country	:	US
Telephone Number	:	734-677-7400
Fax Number	:	734-677-7407

Provider Business Practice Location Address
First Line	:	45 ST LAWRENCE DR
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8310
Country	:	US
Telephone Number	:	419-448-3100
Fax Number	:	419-448-3155

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KOMMULA C RAO
Credential	:	M.D.
Telephone Number	:	419-447-3100

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/14/2009

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Directions to “DRS. HOFFMAN, BIRMINGHAM & ASSOCIATES, INC. ” Practice Location

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