Healthcare Provider Details

I. General information

NPI: 1356582159
Provider Name (Legal Business Name): WILBERT H. HOHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S 4TH ST
ST CHARLES IL
60174-2707
US

IV. Provider business mailing address

405 S 4TH ST
ST CHARLES IL
60174-2707
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-1496
  • Fax:
Mailing address:
  • Phone: 630-584-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-038806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: