Provider Demographics
NPI:1083635866
Name:HOFFMAN, MICHAEL S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2504
Mailing Address - Country:US
Mailing Address - Phone:812-339-1675
Mailing Address - Fax:812-339-5271
Practice Address - Street 1:203 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2504
Practice Address - Country:US
Practice Address - Phone:812-339-1675
Practice Address - Fax:812-339-5271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000315A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100224230Medicaid
IN480029018OtherRRMR
IN100224230Medicaid
IN740840Medicare ID - Type UnspecifiedINDIANA MEDICARE NUMBER