Provider Demographics
NPI:1184686685
Name:HODOR, KENNETH RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:HODOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20295 NE 29TH PL
Mailing Address - Street 2:SUITE# 300
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4109
Mailing Address - Country:US
Mailing Address - Phone:305-932-7366
Mailing Address - Fax:305-932-1271
Practice Address - Street 1:20295 NE 29TH PL
Practice Address - Street 2:SUITE# 300
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4109
Practice Address - Country:US
Practice Address - Phone:305-932-7366
Practice Address - Fax:305-932-1271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0017075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0525847007OtherCIGNA
FL4592937OtherAETNA
FL91939OtherBLUE CROSS BLUE SHIELD
FL200075OtherAVMED
FL0525847007OtherCIGNA
FL4592937OtherAETNA