Healthcare Provider Details

I. General information

NPI: 1528309879
Provider Name (Legal Business Name): ELITA LOIS HOHNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 10/03/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 63RD ST
WOODRIDGE IL
60517-1369
US

IV. Provider business mailing address

15300 WEST AVE STE 223
ORLAND PARK IL
60462-4509
US

V. Phone/Fax

Practice location:
  • Phone: 630-716-7510
  • Fax:
Mailing address:
  • Phone: 708-923-7874
  • Fax: 708-923-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036140334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: