MEDICARE: DR. RICHARD M. HOFACKER, 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	213E00000X	Podiatrist	36002429	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27068924400	OTHER	OH	MEDICAL MUTUAL
2	000000139318	OTHER	OH	ANTHEM BLUE CROSS AND BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588829212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RICHARD M. HOFACKER, INC.

Provider Business Mailing Address
First Line	:	50 SAND RUN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-6200
Country	:	US
Telephone Number	:	330-836-7475
Fax Number	:	330-836-5100

Provider Business Practice Location Address
First Line	:	50 SAND RUN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-6200
Country	:	US
Telephone Number	:	330-836-7475
Fax Number	:	330-836-5100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD MICHAEL HOFACKER
Credential	:	DPM
Telephone Number	:	330-836-7475

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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