=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003912395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J HODOS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833-C WAKE FOREST BUSINESS PARK
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-570-9061
-----------------------------------------------------
Fax | 919-570-9064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 C WAKE FOREST BUSINESS PARK
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-570-9061
-----------------------------------------------------
Fax | 919-570-9064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | POD000792
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 512
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------