Provider Demographics
NPI:1104823566
Name:HODGES, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 W BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5150
Mailing Address - Country:US
Mailing Address - Phone:812-423-3131
Mailing Address - Fax:812-426-7020
Practice Address - Street 1:1020 W BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5150
Practice Address - Country:US
Practice Address - Phone:812-423-3131
Practice Address - Fax:812-426-7020
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055572A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200357080AMedicaid
IN534080GMedicare ID - Type Unspecified