Provider Demographics
NPI:1013989805
Name:TOOFAN, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:TOOFAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 AVENUE OF MID AMERICA
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4634
Mailing Address - Country:US
Mailing Address - Phone:217-994-9301
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENUE OF MID AMERICA
Practice Address - Street 2:SUITE 4
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4634
Practice Address - Country:US
Practice Address - Phone:217-994-9301
Practice Address - Fax:217-994-9304
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112112207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112112Medicaid
ILI38110Medicare UPIN
IL036112112Medicaid