Provider Demographics
NPI:1639250889
Name:HOFFMAN, LEE MARSHALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARSHALL
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5755 W MAPLE RD
Mailing Address - Street 2:STE 115
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-626-7180
Mailing Address - Fax:248-626-7175
Practice Address - Street 1:5755 W MAPLE RD
Practice Address - Street 2:STE 115
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-626-7180
Practice Address - Fax:248-626-7175
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000829213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1308930Medicaid
791480382OtherRAILROAD MEDICARE
MI15990OtherGREAT LAKES HEALTH PLAN
MI50051OtherOMNICARE
574381OtherFIRST HEALTH
MI0F37115002OtherBLUE SHIELD
4426972OtherUNITED HEALTH CARE
MI480F335300OtherBLUE SHIELD
MILH000829OtherBLUE SHIELD
0452330001OtherADMINASTAR DME
128831OtherPREFERRED HEALTH PLAN
MIDR630728OtherPARTNER HEALTH
MIT34416OtherHEALTH ALLIANCE PLAN
MI27582OtherOMNICARE
MI3297999Medicaid
4426972OtherAETNA
480024166OtherRAILROAD MEDICARE
LH000829OtherBLUE SHIELD FEDERAL EMPL
MI1002247-0003OtherTHE WELLNESS PLAN
MI128831OtherCARE CHOICES
MI381910031OtherDMC PPO
MI480F311010OtherBLUE SHIELD
MI4949608Medicaid
LH000829OtherBLUE SHIELD FEDERAL EMPL
MIDR630728OtherPARTNER HEALTH
MI0F37115002OtherBLUE SHIELD
4426972OtherUNITED HEALTH CARE
5987390001Medicare NSC
0828050001Medicare NSC