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General NPI Number Information
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NPI Number | 1770771909
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Entity Type | Organization
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Legal Business Name | KATHLEEN A HODGMAN MD PC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 912 NORTHWEST HWY SUITE 106
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City | FOX RIVER GROVE
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State | IL
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Zip | 60021-1925
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Country | US
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Telephone | 847-462-8050
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Fax | 847-462-8055
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Provider Business Mailing Address
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Address Line | 912 NORTHWEST HWY SUITE 106
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City | FOX RIVER GROVE
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State | IL
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Zip | 60021-1925
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Country | US
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Telephone | 847-462-8050
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Fax | 847-462-8055
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. KATHLEEN A HODGMAN
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Credential | MD
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Telephone | 847-462-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-048484
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License Number State | IL
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