Healthcare Provider Details

I. General information

NPI: 1568479723
Provider Name (Legal Business Name): FREDERICK HOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST FL 4
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

201 E HURON ST FL 4
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-3690
  • Fax: 312-695-5645
Mailing address:
  • Phone: 312-695-3690
  • Fax: 312-695-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036.078774
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.078774
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: