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General NPI Number Information
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NPI Number | 1104833961
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Entity Type | Individual
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Provider Name | JEREMY M HOENIG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE EMS BUILDING, SECTION OF EMERGENCY MEDICINE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-327-2549
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Fax | 708-327-2548
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Provider Business Mailing Address
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Address Line | 3427 WESLEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-3606
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Country | US
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Telephone | 708-484-3118
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Fax | 708-788-0695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | IL
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