Provider Demographics
NPI:1750404174
Name:HOFFMAN, MICHAEL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1520
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3758
Mailing Address - Country:US
Mailing Address - Phone:312-321-9486
Mailing Address - Fax:312-467-9534
Practice Address - Street 1:500 N. MICHIGAN AVE.
Practice Address - Street 2:SUITE 1520
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3758
Practice Address - Country:US
Practice Address - Phone:312-321-9486
Practice Address - Fax:312-467-9534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-433092084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
462270Medicare ID - Type Unspecified
012327Medicare UPIN