Provider Demographics
NPI:1780826370
Name:HOFFERICA, EVELYN HANI (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:HANI
Last Name:HOFFERICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:HANI
Other - Last Name:FAKHOURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2875 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:708-692-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129403207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01421150OtherMEDICARE RAILROAD
ILF400146778OtherMEDICARE
IL036129403Medicaid