Healthcare Provider Details

I. General information

NPI: 1477502219
Provider Name (Legal Business Name): WILLIAM P HODOUS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

IV. Provider business mailing address

13516 HWY F
NEWTON WI
53063
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax:
Mailing address:
  • Phone: 920-726-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number560
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: