MEDICARE: CLARETTA HODGES M.D.

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	207L00000X	Anesthesiology Physician	036045093	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050076615	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01622034	OTHER	IL	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356365233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARETTA HODGES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 388320
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8320
Country	:	US
Telephone Number	:	773-767-4600
Fax Number	:	773-767-8320

Provider Business Practice Location Address
First Line	:	45 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4200
Country	:	US
Telephone Number	:	773-995-3057
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/27/2009

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