Organization Name: | BLOOMINGTON PODIATRY CENTRE LLC |
NPI Number: | 1003048372 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL S HOFFMAN (PODIATRIST) |
Mailing Address: | 203 W 1st St Bloomington |
State: | IN US |
Postal Code: | 474032504 |
Phone Number: | 8123391675 |
Fax Number: | 8123395271 |
NPI Enumeration Date: | 08/19/2009 |
NPI Last Update Date: | 08/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |