MEDICARE: GEORGE E. HOSSFELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	036-060502	IL

General Provider Information

NPI Number	:	1477668242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE E. HOSSFELD MD

Provider Business Mailing Address
First Line	:	809 S MARSHFIELD AVE
Second Line	:	9TH FLOOR (M/C 732)
City	:	CHICAGO
State	:	IL
Zip	:	60612-4305
Country	:	US
Telephone Number	:	312-996-7699
Fax Number	:	312-996-1001

Provider Business Practice Location Address
First Line	:	809 S MARSHFIELD AVE
Second Line	:	9TH FLOOR (M/C 732)
City	:	CHICAGO
State	:	IL
Zip	:	60612-4305
Country	:	US
Telephone Number	:	312-996-7699
Fax Number	:	312-996-1001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	06/22/2010

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