MEDICARE: DR. MICHAEL J HODGE 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	208600000X	Surgery Physician	MD024554	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588641187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J HODGE MD

Provider Business Mailing Address
First Line	:	PO BOX 632476
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2476
Country	:	US
Telephone Number	:	423-975-0764
Fax Number	:	423-975-0141

Provider Business Practice Location Address
First Line	:	2333 KNOB CREEK RD STE 16
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2007
Country	:	US
Telephone Number	:	423-975-0764
Fax Number	:	423-975-0141

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	02/17/2025

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