Healthcare Provider Details

I. General information

NPI: 1730342577
Provider Name (Legal Business Name): HANS BLAAKMAN DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 NORTH GROVE MEDICAL PARK DRIVE
SPARTANBURG SC
29303-4222
US

IV. Provider business mailing address

269 NORTH GROVE MEDICAL PARK DRIVE
SPARTANBURG SC
29303-4222
US

V. Phone/Fax

Practice location:
  • Phone: 864-586-3131
  • Fax: 864-586-3200
Mailing address:
  • Phone: 864-586-3131
  • Fax: 864-586-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00564
License Number StateSC

VIII. Authorized Official

Name: DR. HANS E BLAAKMAN
Title or Position: OWNER
Credential: DPM
Phone: 864-586-3131