MEDICARE: DR. KATHLEEN A. HODGMAN 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	36048484	IL
2	207Q00000X	Family Medicine Physician	036048484	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04900710	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285725929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN A. HODGMAN MD

Provider Business Mailing Address
First Line	:	6601 COLLEGE BLVD STE 120
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1504
Country	:	US
Telephone Number	:	913-359-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	453 S VERMONT ST STE C
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-6968
Country	:	US
Telephone Number	:	913-359-6001
Fax Number	:	319-359-5552

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	11/07/2023

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