Provider Demographics
NPI:1265797427
Name:CHODKIEWICZ, HUBERT MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:MARTIN
Last Name:CHODKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 S LAKELINE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2715
Mailing Address - Country:US
Mailing Address - Phone:512-617-3000
Mailing Address - Fax:512-309-7034
Practice Address - Street 1:200 S LAKELINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2715
Practice Address - Country:US
Practice Address - Phone:512-617-3000
Practice Address - Fax:512-572-5186
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5371207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology