Healthcare Provider Details

I. General information

NPI: 1043317373
Provider Name (Legal Business Name): PETER M.C. HOFMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER M. HOFMANN

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 1ST ST
SPRINGFIELD IL
62702-3749
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-523-0348
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036-110776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: