Healthcare Provider Details

I. General information

NPI: 1104803105
Provider Name (Legal Business Name): ELIZABETH M HOFMEISTER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 WEST DIVISION ST
MANTENO IL
60950-1518
US

IV. Provider business mailing address

2825 WEST DIVISION ST
MANTENO IL
60950-1518
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-7117
  • Fax: 815-468-7510
Mailing address:
  • Phone: 815-468-7117
  • Fax: 815-468-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: