Provider Demographics
NPI:1093840613
Name:HOFFMAN, MICHAEL DARRYL (COF)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DARRYL
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5607
Mailing Address - Country:US
Mailing Address - Phone:630-686-3922
Mailing Address - Fax:630-566-5939
Practice Address - Street 1:7640 PLAZA CT
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5607
Practice Address - Country:US
Practice Address - Phone:630-686-3922
Practice Address - Fax:630-566-5939
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623063OtherBLUE CROSS PROVIDER NUMBE