Healthcare Provider Details

I. General information

NPI: 1467227645
Provider Name (Legal Business Name): HOFFMAN OF LAKEVIEW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 NORTH CLARK STREET
CHICAGO IL
60657
US

IV. Provider business mailing address

443 WEST HURON STREET
CHICAGO IL
60654
US

V. Phone/Fax

Practice location:
  • Phone: 312-481-6544
  • Fax: 312-275-8325
Mailing address:
  • Phone: 312-481-6544
  • Fax: 312-275-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NATHAN STEVEN HOFFMAN
Title or Position: OWNER
Credential:
Phone: 312-505-0168