MEDICARE: DR. MARTIN JAMES HOGAN D.D.S.

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	1223G0001X	General Practice Dentistry	019.028245	IL

General Provider Information

NPI Number	:	1942529938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN JAMES HOGAN D.D.S.

Provider Business Mailing Address
First Line	:	445 E OHIO ST
Second Line	:	APT. #2509
City	:	CHICAGO
State	:	IL
Zip	:	60611-3302
Country	:	US
Telephone Number	:	248-434-7831
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 E OHIO ST
Second Line	:	APT. #2509
City	:	CHICAGO
State	:	IL
Zip	:	60611-3302
Country	:	US
Telephone Number	:	248-434-7831
Fax Number	:

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

Provider Enumeration Date	:	05/31/2010
Last Update Date	:	05/31/2010

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