Provider Demographics
NPI:1730257783
Name:HOFFMAN, MARILE (MD)
Entity type:Individual
Prefix:DR
First Name:MARILE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARILE
Other - Middle Name:
Other - Last Name:MONJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6900 N PECOS ROAD ATTN: PRIMARY CARE SERVCE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086
Mailing Address - Country:US
Mailing Address - Phone:702-791-9000
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS ROAD ATTN: PRIMARY CARE SERVCE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-077571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077571 1Medicaid
B20309Medicare UPIN
IL214660 L65423Medicare ID - Type Unspecified
IL036077571 1Medicaid