Provider Demographics
NPI:1265485478
Name:HOFFMAN, WENDELL WALTER (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:WALTER
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-312-7607
Mailing Address - Fax:605-312-7611
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-8120
Practice Address - Fax:605-328-8121
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1770207R00000X, 207RI0200X
IA28139207R00000X, 207RI0200X
MN025994207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8278Medicare PIN
SDS8255Medicare PIN
SD440003518Medicare PIN
D25344Medicare UPIN