Healthcare Provider Details

I. General information

NPI: 1447631239
Provider Name (Legal Business Name): MICHAEL A HOEFT RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 VISA DR. STE 2
NORMAL IL
61761
US

IV. Provider business mailing address

1604 VISA DR. SL STE. 2
NORMAL IL
61761
US

V. Phone/Fax

Practice location:
  • Phone: 309-846-4716
  • Fax: 309-454-7348
Mailing address:
  • Phone: 309-846-4716
  • Fax: 309-454-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number041.385815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: