Healthcare Provider Details

I. General information

NPI: 1265592554
Provider Name (Legal Business Name): BETH O HODGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 VALPARAISO CT HAMMOND CLINIC LLC
MUNSTER IN
46321-1215
US

IV. Provider business mailing address

9800 VALPARAISO CT HAMMOND CLINIC LLC
MUNSTER IN
46321-1215
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax: 219-836-8073
Mailing address:
  • Phone: 219-836-5800
  • Fax: 219-836-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: