Provider Demographics
NPI:1932302668
Name:HODGES, KELLY L (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF CHILD PROTECTION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-277-8980
Mailing Address - Fax:414-277-8969
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF CHILD PROTECTION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-277-8980
Practice Address - Fax:414-277-8969
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2020-10-05
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Provider Licenses
StateLicense IDTaxonomies
WI52848-20208000000X
WI528482080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932302668Medicaid
WI1932302668Medicaid