Healthcare Provider Details

I. General information

NPI: 1780826370
Provider Name (Legal Business Name): EVELYN HANI HOFFERICA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN HANI FAKHOURY MD

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W 19TH ST
CHICAGO IL
60623-3501
US

IV. Provider business mailing address

PO BOX 631
LAKE FOREST IL
60045-0631
US

V. Phone/Fax

Practice location:
  • Phone: 708-692-9525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-129403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: