1639250889 NPI number — DR. LEE MARSHALL HOFFMAN DPM

Table of content: DR. LEE MARSHALL HOFFMAN DPM (NPI 1639250889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639250889 NPI number — DR. LEE MARSHALL HOFFMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMAN
Provider First Name:
LEE
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639250889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5755 W MAPLE RD
Provider Second Line Business Mailing Address:
STE 115
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-626-7180
Provider Business Mailing Address Fax Number:
248-626-7175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5755 W MAPLE RD
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-626-7180
Provider Business Practice Location Address Fax Number:
248-626-7175
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  5901000829 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1308930 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 791480382 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15990 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50051 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 574381 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0F37115002 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4426972 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480F335300 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: LH000829 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0452330001 . This is a "ADMINASTAR DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 128831 . This is a "PREFERRED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: DR630728 . This is a "PARTNER HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: T34416 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 27582 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3297999 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4426972 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480024166 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: LH000829 . This is a "BLUE SHIELD FEDERAL EMPL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1002247-0003 . This is a "THE WELLNESS PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 128831 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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