Provider Demographics
NPI:1578011474
Name:HANS BLAAKMAN DPM LLC
Entity Type:Organization
Organization Name:HANS BLAAKMAN DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:HANS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAAKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-586-3131
Mailing Address - Street 1:269 N GROVE MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4222
Mailing Address - Country:US
Mailing Address - Phone:864-586-3131
Mailing Address - Fax:864-586-3200
Practice Address - Street 1:269 NORTH GROVE MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-586-3131
Practice Address - Fax:864-586-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty