Provider Demographics
NPI:1992786198
Name:HOFFMAN, THERESA K (DO)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:K
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:10215 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2387
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:260-234-5110
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2025-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02001618A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332830Medicaid
000000091879OtherBLUE CROSS BLUE SHIELD
INP00978940OtherRAILROAD MEDICARE
INP00978940OtherRAILROAD MEDICARE
F63224Medicare UPIN
IN925510OMedicare PIN
5831OtherPHYSICIANS HEALTH PLAN
000000091879OtherBLUE CROSS BLUE SHIELD
IN080121940OtherRAILROAD MEDICARE
INM400048200Medicare PIN