Provider Demographics
NPI:1821098575
Name:HODAKOWSKI, GEORGE TADEUSZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:TADEUSZ
Last Name:HODAKOWSKI
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 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:120 N OAK ST
Practice Address - Street 2:2ND FLOOR, EAST WING
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3829
Practice Address - Country:US
Practice Address - Phone:630-568-3882
Practice Address - Fax:630-568-3886
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045222A208G00000X
IL036078800208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821098575Medicaid
IN200123500EMedicaid
IN200123500CMedicaid
IN200123500AMedicaid
IN200123500BMedicaid
IN200123500DMedicaid
IL036078800Medicaid
ILE35482Medicare UPIN
IL036078800Medicaid
IN200123500DMedicaid
IL535550006Medicare PIN
IN200123500AMedicaid
IN408430FMedicare PIN
ILK17112Medicare PIN
IN060059887Medicare PIN
ILL78987Medicare PIN
IN780002105Medicare PIN