Provider Demographics
NPI:1992805493
Name:HOFELICH, CHRISTOPHER SHAWN (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:HOFELICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7100
Mailing Address - Country:US
Mailing Address - Phone:812-282-1617
Mailing Address - Fax:
Practice Address - Street 1:41 QUATERMASTER CT.
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3623
Practice Address - Country:US
Practice Address - Phone:812-282-1617
Practice Address - Fax:812-288-7325
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003983A207R00000X, 207RC0000X, 207RI0011X
OH34-008723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201075760Medicaid
OH2648246Medicaid
ININ1189043OtherIN MEDICARE