1225370521 NPI number — RYAN CHRISTOPHER HOFLER M.D.

Table of content: RYAN CHRISTOPHER HOFLER M.D. (NPI 1225370521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225370521 NPI number — RYAN CHRISTOPHER HOFLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFLER
Provider First Name:
RYAN
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225370521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 S 1ST AVE
Provider Second Line Business Mailing Address:
LOYOLA OUTPATIENT CENTER, 4300
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60153-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-216-1676
Provider Business Mailing Address Fax Number:
708-216-4834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 S LIMESTONE
Provider Second Line Business Practice Location Address:
STE B101
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-5661
Provider Business Practice Location Address Fax Number:
859-323-5943
Provider Enumeration Date:
03/25/2013

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: 207T00000X , with the licence number:  125063152 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 55568 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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