Healthcare Provider Details

I. General information

NPI: 1285685016
Provider Name (Legal Business Name): MARK E HODGSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MAYFAIR RD STE 670 SUITE 670
MILWAUKEE WI
53226-1444
US

IV. Provider business mailing address

2500 N MAYFAIR RD STE 670 SUITE 670
MILWAUKEE WI
53226-1444
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-7418
  • Fax: 414-453-7420
Mailing address:
  • Phone: 414-453-7418
  • Fax: 414-453-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number47914
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number47914
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: