Healthcare Provider Details

I. General information

NPI: 1932217924
Provider Name (Legal Business Name): JAMES W HOFTIEZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WOODLAND DR
MANITOWOC WI
54220-9662
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-6212
  • Fax: 920-684-5548
Mailing address:
  • Phone: 920-320-2591
  • Fax: 920-684-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22886
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30307800
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer
# 2
Identifier3908063950002
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerCHAMPUS
# 3
IdentifierB53650
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerNETWORK HEALTHPLAN
# 4
Identifier110080078
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerRAILROAD MEDICARE
# 5
Identifier7805
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerANTHEM
# 6
Identifier100003091
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerWEA
# 7
Identifier22886
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerTOUCHPOINT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: