MEDICARE: DR. JAMES MICHAEL HUDSON D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1831192558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL HUDSON D.M.D.

Provider Business Mailing Address
First Line	:	2 N COUNTRY CLUB RD
Second Line	:	STE 1
City	:	DECATUR
State	:	IL
Zip	:	62521-4173
Country	:	US
Telephone Number	:	217-429-7070
Fax Number	:	217-429-7189

Provider Business Practice Location Address
First Line	:	2 N COUNTRY CLUB RD
Second Line	:	STE 1
City	:	DECATUR
State	:	IL
Zip	:	62521-4173
Country	:	US
Telephone Number	:	217-429-7070
Fax Number	:	217-429-7189

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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