Healthcare Provider Details

I. General information

NPI: 1497782098
Provider Name (Legal Business Name): GREG A HODDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

4059 COREY CIR
ANN ARBOR MI
48103-9477
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-3114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number070381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: