Provider Demographics
NPI:1972534642
Name:HOFSOMMER, LEE A (DPM)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:HOFSOMMER
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2700488OtherMEDICA #
ND41093OtherLHS #
ND593525300Medicaid
ND117307OtherUCARE #
ND15387Medicaid
NDHP21437OtherHEALTHPARTNERS #
ND20314OtherAMERICA'S PPO/ARAZ #
ND25446OtherNDBS #
NDDA9011008260OtherPREFERRED ONE #
ND2700493OtherMEDICA #
ND466L6HOOtherMNBS #
ND593525300Medicaid
NDDA9011008260OtherPREFERRED ONE #
ND20314OtherAMERICA'S PPO/ARAZ #
ND2700488OtherMEDICA #