Healthcare Provider Details

I. General information

NPI: 1467554717
Provider Name (Legal Business Name): DAVID ALAN HODGETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE SUITE 115
AURORA IL
60504-7206
US

IV. Provider business mailing address

1256 WATERFORD DRIVE SUITE 230
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0200
  • Fax: 630-585-7396
Mailing address:
  • Phone: 630-692-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036087158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: