Healthcare Provider Details

I. General information

NPI: 1083635866
Provider Name (Legal Business Name): MICHAEL S HOFFMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W 1ST ST
BLOOMINGTON IN
47403-2504
US

IV. Provider business mailing address

203 W 1ST ST
BLOOMINGTON IN
47403-2504
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-1675
  • Fax: 812-339-5271
Mailing address:
  • Phone: 812-339-1675
  • Fax: 812-339-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000315A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: