Healthcare Provider Details

I. General information

NPI: 1104823566
Provider Name (Legal Business Name): MICHAEL R HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W BUENA VISTA RD
EVANSVILLE IN
47710-5150
US

IV. Provider business mailing address

1020 W BUENA VISTA RD
EVANSVILLE IN
47710-5150
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-3131
  • Fax: 812-426-7020
Mailing address:
  • Phone: 812-423-3131
  • Fax: 812-426-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01055572A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: