Provider Demographics
NPI:1699839365
Name:HOFFMEISTER, MARTIN G (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:HOFFMEISTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001390213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
382765698OtherTAX IDENTIFICATION
MI3136719Medicaid
MIMH001390OtherBLUE CROSS OF MI
480008298OtherRAILROAD MEDICARE
T34016Medicare UPIN
MIMH001390OtherBLUE CROSS OF MI