Provider Demographics
NPI:1790048502
Name:ABID-HOFFMAN, FARWA (DPM)
Entity Type:Individual
Prefix:MRS
First Name:FARWA
Middle Name:
Last Name:ABID-HOFFMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 W JEFFERSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2795
Mailing Address - Country:US
Mailing Address - Phone:317-346-7722
Mailing Address - Fax:317-346-7725
Practice Address - Street 1:1159 W JEFFERSON ST STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:317-346-7725
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001206A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201290040Medicaid
508770005OtherPTAN