Provider Demographics
NPI:1285725929
Name:HODGMAN, KATHLEEN A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:HODGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 COLLEGE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1504
Mailing Address - Country:US
Mailing Address - Phone:913-359-6001
Mailing Address - Fax:
Practice Address - Street 1:453 S VERMONT ST STE C
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6968
Practice Address - Country:US
Practice Address - Phone:913-359-6001
Practice Address - Fax:319-359-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36048484207Q00000X
IL036048484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04900710OtherBLUE CROSS BLUE SHIELD
IL036048484Medicaid
IL246310Medicare PIN
IL04900710OtherBLUE CROSS BLUE SHIELD
IL036048484Medicaid