Basic Information
| Provider Information | |||||||||
| NPI: | 1265673784 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANS BLAAKMAN,DPM,LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UPSTATE FOOTCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 N LIMESTONE ST | ||||||||
| Address2: | |||||||||
| City: | GAFFNEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293402312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644873338 | ||||||||
| FaxNumber: | 8644874102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293349218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644873338 | ||||||||
| FaxNumber: | 8644874102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2009 | ||||||||
| LastUpdateDate: | 05/07/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BLAAKMAN | ||||||||
| AuthorizedOfficialFirstName: | HANS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8644873338 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 00564 | SC | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 00564 | SC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8291 | 01 | SC | MEDICARE ID | OTHER | GP4211 | 05 | SC | MEDICAID |