Provider Demographics
NPI:1609853746
Name:HODULIK, REBECCA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:HODULIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 WEST DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1518
Mailing Address - Country:US
Mailing Address - Phone:815-468-7117
Mailing Address - Fax:815-468-7510
Practice Address - Street 1:2825 WEST DIVISION ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1518
Practice Address - Country:US
Practice Address - Phone:815-468-7117
Practice Address - Fax:815-468-7510
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU66469Medicare UPIN