Provider Demographics
NPI:1003912395
Name:HODOS, MICHAEL J (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HODOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 C WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6519
Mailing Address - Country:US
Mailing Address - Phone:919-570-9061
Mailing Address - Fax:919-570-9064
Practice Address - Street 1:833-C WAKE FOREST BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6519
Practice Address - Country:US
Practice Address - Phone:919-570-9061
Practice Address - Fax:919-570-9064
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000792213ES0103X
NC512213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2700036OtherUNITED HEALTHCARE
GA5133456OtherAETNA PPO
GA000728538DMedicaid
GA2162228OtherAETNA HMO
FL480032033OtherRAILROAD MEDICARE
GA000728538CMedicaid
SCGPD792OtherSOUTH CAROLINA MEDICAID
GA2700036OtherUNITED HEALTHCARE
GAU56255Medicare UPIN
FL480032033OtherRAILROAD MEDICARE
GA48SCCGJMedicare ID - Type Unspecified
GA000728538CMedicaid
NC1871847582Medicare NSC