1659423051 NPI number — DR. ELIZABETH NGUYEN KIRCHOFF D.O.

Table of content: DR. ELIZABETH NGUYEN KIRCHOFF D.O. (NPI 1659423051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659423051 NPI number — DR. ELIZABETH NGUYEN KIRCHOFF D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHOFF
Provider First Name:
ELIZABETH
Provider Middle Name:
NGUYEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659423051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 COMMUNITY MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60525-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-245-8900
Provider Business Mailing Address Fax Number:
708-245-5604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 COMMUNITY MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60525-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-245-8900
Provider Business Practice Location Address Fax Number:
708-245-5604
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036-116867 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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