MEDICARE: MICHAEL HOGG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	58305	KY
2	390200000X	Student in an Organized Health Care Education/Training Program		KY

General Provider Information

NPI Number	:	1043717978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOGG

Provider Business Mailing Address
First Line	:	1901 CAMPUS PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 KRESGE WAY STE 207
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4637
Country	:	US
Telephone Number	:	502-893-0220
Fax Number	:	502-893-0563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2018
Last Update Date	:	05/06/2026

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Directions to “ MICHAEL HOGG ” Practice Location

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