Healthcare Provider Details

I. General information

NPI: 1023116175
Provider Name (Legal Business Name): MICHAEL G HOFFMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BANKVIEW DR STE B
FRANKFORT IL
60423-1490
US

IV. Provider business mailing address

600 BANKVIEW DR STE B
FRANKFORT IL
60423-1490
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-3377
  • Fax: 815-469-3370
Mailing address:
  • Phone: 815-469-3377
  • Fax: 815-469-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-018638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: