Healthcare Provider Details

I. General information

NPI: 1629489828
Provider Name (Legal Business Name): REBECCA HOFFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2014
Last Update Date: 05/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ELMWOOD AVE
WILMETTE IL
60091-1649
US

IV. Provider business mailing address

1300 ELMWOOD AVE
WILMETTE IL
60091-1649
US

V. Phone/Fax

Practice location:
  • Phone: 847-251-0143
  • Fax:
Mailing address:
  • Phone: 847-251-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036071845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: