Provider Demographics
NPI:1104803105
Name:HOFMEISTER, ELIZABETH M (DPM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2825 WEST DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1518
Mailing Address - Country:US
Mailing Address - Phone:815-468-7117
Mailing Address - Fax:815-468-7510
Practice Address - Street 1:2825 WEST DIVISION ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1518
Practice Address - Country:US
Practice Address - Phone:815-468-7117
Practice Address - Fax:815-468-7510
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU17797Medicare UPIN