Provider Demographics
NPI:1588647762
Name:HODGIN, PHILLIP T JR (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:T
Last Name:HODGIN
Suffix:JR
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 1:10330 N MERIDIAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13250 HAZEL DELL PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8521
Practice Address - Country:US
Practice Address - Phone:317-415-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025369A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121700Medicaid
IN220620NMedicare PIN
D95346Medicare UPIN