Provider Demographics
NPI:1467554717
Name:HODGETT, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:HODGETT
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 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-692-5208
Mailing Address - Fax:
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7206
Practice Address - Country:US
Practice Address - Phone:630-585-0200
Practice Address - Fax:630-585-7396
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087158208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087158Medicaid
ILK19926Medicare UPIN