Organization
SPECIALTY MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D. HOFFMAN COF (OWNER)
(847) 390-8939
Entity
Organization
Contact information
Practice address
479 E BUSINESS CENTER DR, SUITE 108, MOUNT PROSPECT, IL 60056-6037
(847) 390-8939
(847) 390-8937
Mailing address
479 E BUSINESS CENTER DR, SUITE 108, MOUNT PROSPECT, IL 60056-6037
(847) 390-8939
(847) 390-8937
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623063
BLUE CROSS PROVIDER NUMBE
IL
01
—
COF00453
ABC ACCREDIDATION NUMBER
IL
Enumeration date
06/28/2007
Last updated
08/22/2020
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