Individual
KENNETH M HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
Mailing address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
(502) 213-3853
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
01040152A
IN
207RX0202X
Medical Oncology Physician
22157
KY
207Y00000X
Otolaryngology Physician
01040152A
IN
207Y00000X
Otolaryngology Physician
Primary
22157
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040003868
MEDICARE RR
KY
05
—
64221575
—
KY
Enumeration date
06/30/2005
Last updated
11/15/2022
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