Provider Demographics
NPI:1659620029
Name:HODGES, JAMES GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GABRIEL
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABE
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:3433 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2895
Practice Address - Country:US
Practice Address - Phone:773-242-2299
Practice Address - Fax:773-830-1920
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036147039207R00000X
TXP8252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program