Healthcare Provider Details

I. General information

NPI: 1992805493
Provider Name (Legal Business Name): CHRISTOPHER SHAWN HOFELICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 QUATERMASTER CT.
JEFFERSONVILLE IN
47130-3623
US

IV. Provider business mailing address

1713 E 10TH ST
JEFFERSONVILLE IN
47130-7100
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-1617
  • Fax: 812-288-7325
Mailing address:
  • Phone: 812-282-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02003983A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34-008723
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02003983A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number02003983A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: