Provider Demographics
NPI:1891004404
Name:HODOGBEY, PRINCE LOLONYO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:LOLONYO
Last Name:HODOGBEY
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:PO BOX 3603
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3603
Mailing Address - Country:US
Mailing Address - Phone:773-772-7858
Mailing Address - Fax:773-276-6668
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:312-337-1982
Practice Address - Fax:312-642-3847
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129113207Q00000X
IL125056495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214667012OtherMEDICARE
IL36129113Medicaid
IL12445676OtherCAQH
IL36129113Medicaid