Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036089617 | IL |
NPI | 1043217490 |
---|---|
Provider Name | Elisa A Hofmann |
First Address | Geneva, IL 60134-4205 |
Second Address | Geneva, IL 60134-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 23/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089617 | (05) | IL |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
206147115 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |
CA4748 | MEDICARE RAILROAD (GROUP PTAN) (01) | IL |
G58320 | (02) | IL |
P01209463 | MEDICARE RAILROAD (PROVIDER PTAN) (01) | IL |