Healthcare Provider Details

I. General information

NPI: 1871073114
Provider Name (Legal Business Name): KEVIN HOCHSTRASSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST FL 19
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

259 E ERIE ST FL 19
CHICAGO IL
60611-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax:
Mailing address:
  • Phone: 312-695-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036.17503
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: