MEDICARE: GEORGE HOGANSON MD

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	207SG0201X	Clinical Genetics (M.D.) Physician	036-073221	IL
2	207SG0202X	Clinical Biochemical Genetics Physician	036-073221	IL
3	207SG0203X	Clinical Molecular Genetics Physician	036-073221	IL
4	208000000X	Pediatrics Physician	036-073221	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07215036	OTHER	IL	BCBS
2	IL0194	OTHER	IL	JOHN DEERE

General Provider Information

NPI Number	:	1164497483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE HOGANSON MD

Provider Business Mailing Address
First Line	:	840 S WOOD ST
Second Line	:	M/C 856
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-355-0732
Fax Number	:	312-355-0739

Provider Business Practice Location Address
First Line	:	840 S WOOD ST
Second Line	:	M/C 856
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-355-0732
Fax Number	:	312-355-0739

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	12/05/2007

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Directions to “ GEORGE HOGANSON MD” Practice Location

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