Healthcare Provider Details

I. General information

NPI: 1639250889
Provider Name (Legal Business Name): LEE MARSHALL HOFFMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 W MAPLE RD STE 115
WEST BLOOMFIELD MI
48322-4415
US

IV. Provider business mailing address

5755 W MAPLE RD STE 115
WEST BLOOMFIELD MI
48322-4415
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-7180
  • Fax: 248-626-7175
Mailing address:
  • Phone: 248-626-7180
  • Fax: 248-626-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: