IndividualActive
Mario Hodge, C.PED
NPI 1023369501 · Pedorthist · Mount Vernon, IL
Provider details
- NPI number
- 1023369501
- Entity type
- Individual
- Primary specialty
- PedorthistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- C.PED
- Sex
- Male
- Sole proprietor
- No
- License
- 212.000161 (IL)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1024 Jordan St
Mount Vernon, IL 62864-4231
Phone: (618) 242-4442
Fax: (618) 242-3942
Approximate (ZIP-level) locationGet directions
Mailing address
1024 Jordan St
Mount Vernon, IL 62864-4231
Registry dates
- Enumerated
- 2012-09-25
- Last updated
- 2012-09-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.