Individual
KIM J HODGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 W MILLER ST, SPRINGFIELD, IL 62702-4928
(217) 545-5555
(217) 545-2563
Mailing address
PO BOX 19638, SPRINGFIELD, IL 62794-9638
(217) 545-5555
(217) 545-2563
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036072794
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072794
—
IL
Enumeration date
09/20/2005
Last updated
10/16/2014
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