MEDICARE: BERT S HODOUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	45632	WI

General Provider Information

NPI Number	:	1023008547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERT S HODOUS MD

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54702-1510
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 DETTLOFF DR
Second Line	:
City	:	ARCADIA
State	:	WI
Zip	:	54612
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	01/07/2022

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