| Enisa Hodzic, MD | |
|
1640 E Sumner St, Hartford, WI 53027-2684 | |
| (262) 670-4000 | |
| Not Available |
| Full Name | Enisa Hodzic |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 1640 E Sumner St, Hartford, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285869560 | NPI | - | NPPES |
| 100023662 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 57244 (Wisconsin) | Primary |
| Entity Name | Aurora Medical Group, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427271378 PECOS PAC ID: 6709794258 Enrollment ID: O20031105000725 |
| Entity Name | Lakeshore Medical Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003861188 PECOS PAC ID: 7719890730 Enrollment ID: O20031106000481 |
| Entity Name | Aurora Advanced Healthcare, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1265629133 PECOS PAC ID: 3375625833 Enrollment ID: O20080123000694 |
| Mailing Address | Practice Location Address |
|---|---|
| Enisa Hodzic, MD Po Box 735044, Chicago, IL 60673-5044 Ph: () - | Enisa Hodzic, MD 1640 E Sumner St, Hartford, WI 53027-2684 Ph: (262) 670-4000 |
Brianna Lynn Bobber, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 1640 E Sumner St, Hartford, WI 53027 Phone: 262-670-4000 | |
Dr. Ronald G Gritt, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1640 E Sumner St, Hartford, WI 53027 Phone: 262-670-4000 Fax: 262-670-4451 |