Provider Demographics
NPI:1265673784
Name:HANS BLAAKMAN,DPM,LLC
Entity Type:Organization
Organization Name:HANS BLAAKMAN,DPM,LLC
Other - Org Name:UPSTATE FOOTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAAKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-487-3338
Mailing Address - Street 1:1604 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2312
Mailing Address - Country:US
Mailing Address - Phone:864-487-3338
Mailing Address - Fax:864-487-4102
Practice Address - Street 1:1575 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9218
Practice Address - Country:US
Practice Address - Phone:864-487-3338
Practice Address - Fax:864-487-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00564213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8291OtherMEDICARE ID
SCGP4211Medicaid
SC6129140002Medicare NSC
SC8291OtherMEDICARE ID