Provider Demographics
NPI:1164433181
Name:BOFFA, JAMES FRANK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANK
Last Name:BOFFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:FRANK
Other - Last Name:BOFFA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-273-6810
Practice Address - Fax:773-271-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086529208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086529 4Medicaid
IL5077503OtherAETNA
IL036086529 2Medicaid
IL0001630046OtherBC BS OF IL
IL020053474Medicare PIN
ILL84942Medicare PIN
ILL94232Medicare PIN
IL036086529 2Medicaid