Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | IL |
NPI | 1134197833 |
---|---|
Provider Name | Kennth Alan Hodel |
First Address | Peoria, IL 61614 |
Second Address | Peoria, IL 61614-2851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24511 | (02) | |
A24511 | (05) | IL |