MEDICARE: MATTHEW NICHOLAS HODROSKY PA

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	363AS0400X	Surgical Physician Assistant	5601004701	MI
2	363AM0700X	Medical Physician Assistant	50002129	OH

General Provider Information

NPI Number	:	1538166616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW NICHOLAS HODROSKY PA

Provider Business Mailing Address
First Line	:	P.O. BOX 0446 24 FRANK LLOYD WRIGHT DR. LOBBY J
Second Line	:	IHA
City	:	ANN ARBOR
State	:	MI
Zip	:	48106
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:	734-222-3100

Provider Business Practice Location Address
First Line	:	5315 ELLIOTT DR STE 304
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-8634
Country	:	US
Telephone Number	:	734-712-0655
Fax Number	:	734-712-0611

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/27/2017

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