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NPI Code Detail

MEDICARE: DR. MICHAEL JOHN HUDOCK JR. DO

MEDICARE: DR. MICHAEL JOHN HUDOCK JR. DO
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
12081P0010XPediatric Rehabilitation Medicine Physician58.034108OH
2208100000XPhysical Medicine & Rehabilitation Physician2020018212MO

General Provider Information

NPI Number : 1558987099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL JOHN HUDOCK JR. DO
Provider Business Mailing Address
First Line : 3333 BURNET AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3026
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3333 BURNET AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3026
Country : US
Telephone Number : 314-362-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2020
Last Update Date : 12/28/2024

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Directions to “ DR. MICHAEL JOHN HUDOCK JR. DO” Practice Location

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