Healthcare Provider Details

I. General information

NPI: 1063796563
Provider Name (Legal Business Name): KRISTIN VICTORIA HOFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TORRENCE AVE
CALUMET CITY IL
60409-5430
US

IV. Provider business mailing address

11S524 WALTER LN
NAPERVILLE IL
60564-5783
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-4961
  • Fax:
Mailing address:
  • Phone: 815-545-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085004150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: