Provider Demographics
NPI:1730147406
Name:HODARKAR, REKHA J (MD)
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:J
Last Name:HODARKAR
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 1:8890 THORNTREE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1531
Mailing Address - Country:US
Mailing Address - Phone:734-671-1820
Mailing Address - Fax:
Practice Address - Street 1:23901 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-6035
Practice Address - Country:US
Practice Address - Phone:248-357-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041918207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104434878Medicaid
MI050F355980OtherBCBSMI PIN
MI104434878Medicaid
MI0M71810030Medicare ID - Type Unspecified
MI050089425Medicare ID - Type UnspecifiedRAILROAD
MI0P57180003Medicare PIN