Provider Demographics
NPI:1912950056
Name:BLAAKMAN, HANS (DPM)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:
Last Name:BLAAKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 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 N GROVE MEDICAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4222
Practice Address - Country:US
Practice Address - Phone:864-586-3131
Practice Address - Fax:864-586-3200
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC564213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5649Medicaid
SC5669820001OtherDME
SCP00685200OtherRAIL ROAD MEDICARE GROUP MEMBER PTAN #
SCPD5699Medicaid
SCDE2766OtherDME-DR. HANS BLAAKMAN
SCP00685200OtherRAIL ROAD MEDICARE GROUP MEMBER PTAN #
SC5669820001Medicare NSC
SCDE2766OtherDME-DR. HANS BLAAKMAN