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General NPI Number Information
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NPI Number | 1104823566
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Entity Type | Individual
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Provider Name | MICHAEL R HODGES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 1020 W BUENA VISTA RD
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City | EVANSVILLE
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State | IN
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Zip | 47710-5150
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Country | US
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Telephone | 812-423-3131
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Fax | 812-426-7020
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Provider Business Mailing Address
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Address Line | 1020 W BUENA VISTA RD
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City | EVANSVILLE
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State | IN
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Zip | 47710-5150
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Country | US
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Telephone | 812-423-3131
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Fax | 812-426-7020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01055572A
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License Number State | IN
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