Provider Demographics
NPI:1124182456
Name:NORTHFIELD PODIATRY ASSOCIATES P C
Entity Type:Organization
Organization Name:NORTHFIELD PODIATRY ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOFFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-364-8495
Mailing Address - Street 1:2501 PLAINFIELD AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3700
Mailing Address - Country:US
Mailing Address - Phone:616-364-8495
Mailing Address - Fax:616-364-1955
Practice Address - Street 1:2501 PLAINFIELD AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3700
Practice Address - Country:US
Practice Address - Phone:616-364-8495
Practice Address - Fax:616-364-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001390213E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH001390OtherPIN
MH001390OtherPIN
=========OtherTAX IDENTIFICATION
MH001390OtherPIN