=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780604116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEST & SLEEP MEDICINE ASSOCIATES S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 06/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 S MILWAUKEE AVE STE 181
-----------------------------------------------------
City | LIBERTYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60048-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-855-2430
-----------------------------------------------------
Fax | 847-855-2490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 S MILWAUKEE AVE STE 181
-----------------------------------------------------
City | LIBERTYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60048-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-855-2430
-----------------------------------------------------
Fax | 847-855-2490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENNIS HOFFMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-573-9031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 036085568
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 036085568
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------