Healthcare Provider Details

I. General information

NPI: 1164433181
Provider Name (Legal Business Name): JAMES FRANK BOFFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES FRANK BOFFA MD

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 780
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 773-273-6810
  • Fax: 773-271-5532
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036086529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: