Healthcare Provider Details

I. General information

NPI: 1780604116
Provider Name (Legal Business Name): CHEST & SLEEP MEDICINE ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S MILWAUKEE AVE STE 181
LIBERTYVILLE IL
60048-3267
US

IV. Provider business mailing address

755 S MILWAUKEE AVE STE 181
LIBERTYVILLE IL
60048-3267
US

V. Phone/Fax

Practice location:
  • Phone: 847-855-2430
  • Fax: 847-855-2490
Mailing address:
  • Phone: 847-855-2430
  • Fax: 847-855-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036085568
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036085568
License Number StateIL

VIII. Authorized Official

Name: DENNIS HOFFMAN
Title or Position: OWNER
Credential: MD
Phone: 847-573-9031