Basic Information
| Provider Information | |||||||||
| NPI: | 1134147432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 GOOD SAMARITAN WAY | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188994000 | ||||||||
| FaxNumber: | 6188994790 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 GOOD SAMARITAN WAY | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188994000 | ||||||||
| FaxNumber: | 6188994790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036059053 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CE9335 | 01 | IL | RR GROUP | OTHER | 04108659 | 01 | IL | BCBS | OTHER | 010059220 | 01 | IL | MED RAILROAD | OTHER | 036059053 | 05 | IL | MEDICAID | 207988 | 01 | IL | GRP MED | OTHER |