Individual
CLARETTA HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
45 W 111TH ST, CHICAGO, IL 60628-4200
(773) 995-3057
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-4600
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036045093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01622034
BLUE SHIELD
IL
05
—
036045093
—
IL
01
—
050076615
RAILROAD MEDICARE
—
Enumeration date
07/26/2006
Last updated
08/27/2009
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