Healthcare Provider Details

I. General information

NPI: 1063176733
Provider Name (Legal Business Name): TOOFAN MEDICAL HOLDINGS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 KOESTER DR
FORSYTH IL
62535-9625
US

IV. Provider business mailing address

1325 KOESTER DR
FORSYTH IL
62535-9625
US

V. Phone/Fax

Practice location:
  • Phone: 217-330-6868
  • Fax: 213-330-6966
Mailing address:
  • Phone: 217-330-6868
  • Fax: 213-330-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL A TOOFAN
Title or Position: PRESIDENT
Credential: MD
Phone: 217-994-9301