Healthcare Provider Details

I. General information

NPI: 1699839365
Provider Name (Legal Business Name): MARTIN G HOFFMEISTER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49505-3700
US

IV. Provider business mailing address

2501 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49505-3700
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-8495
  • Fax: 616-364-1955
Mailing address:
  • Phone: 616-364-8495
  • Fax: 616-364-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001390
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: