Provider Demographics
NPI:1013080894
Name:HOFFMAN, MICHAEL HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HERBERT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 CUSTER ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4324
Mailing Address - Country:US
Mailing Address - Phone:920-652-9310
Mailing Address - Fax:
Practice Address - Street 1:3415 CUSTER ST
Practice Address - Street 2:SUITE D
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4324
Practice Address - Country:US
Practice Address - Phone:920-652-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI002150264Medicare Oscar/Certification
WI430800027Medicare Oscar/Certification
WI072900049Medicare Oscar/Certification
G32676Medicare UPIN
WI002150203Medicare Oscar/Certification
WI008770101Medicare Oscar/Certification
WIWI1119003Medicare Oscar/Certification
WIWI1097008Medicare Oscar/Certification