Provider Demographics
NPI:1134164163
Name:HODOR, DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:HODOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36622 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2538
Mailing Address - Country:US
Mailing Address - Phone:586-725-3444
Mailing Address - Fax:
Practice Address - Street 1:36622 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2538
Practice Address - Country:US
Practice Address - Phone:586-725-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH400204213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1927090Medicaid
MIT34052Medicare UPIN
MI0420490001Medicare NSC