Healthcare Provider Details

I. General information

NPI: 1093840613
Provider Name (Legal Business Name): MICHAEL DARRYL HOFFMAN C.O.F.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 PLAZA CT
WILLOWBROOK IL
60527-5607
US

IV. Provider business mailing address

7640 PLAZA CT
WILLOWBROOK IL
60527-5607
US

V. Phone/Fax

Practice location:
  • Phone: 630-686-3922
  • Fax: 630-566-5939
Mailing address:
  • Phone: 630-686-3922
  • Fax: 630-566-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: