Basic Information
| Provider Information | |||||||||
| NPI: | 1164408910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 N WESTMORELAND RD | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357917 | ||||||||
| FaxNumber: | 8475357801 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 REMITTANCE DR | ||||||||
| Address2: | SUITE 1951 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606751001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357917 | ||||||||
| FaxNumber: | 8475357801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 36106168 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 36106168 | 05 | IL | MEDICAID |