Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016-005157 | IL |
Y | 222Z00000X | Podiatrist | 016-005157 | IL |
NPI | 1063586196 |
---|---|
Provider Name | Heidi Marie Hoffmann |
First Address | Chicago, IL 60656-2161 |
Second Address | Chicago, IL 60656-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10065157 | (05) | IL |
U99737 | (02) | IL |