Blake Michael Bodendorfer
Sports Medicine Orthopaedic Surgeon
1 Edmundson Pl Ste 500
Council Bluffs
, Iowa 51503-4619
Blake Michael Bodendorfer
Sports Medicine Orthopaedic Surgeon
1 Edmundson Pl Ste 500
Council Bluffs
, Iowa 51503-4619
(708) 409-5179
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About
Features
Specialties
- Sports Medicine Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Blake Michael Bodendorfer
- 1611 W Harrison St Ste 400
- Chicago, IL
- Zip : 60612-4861
- Fax : (708) 409-5179
- Phone : (312) 432-2351
Second Address
- Blake Michael Bodendorfer
- 1 Edmundson Pl Ste 500
- Council Bluffs, IA
- Zip : 51503-4619
- Phone : (712) 323-5333
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036152051 | IL |
National Provider Identifier
| NPI | 1083000905 |
|---|---|
| Provider Name | Blake Michael Bodendorfer |
| First Address | Chicago, IL 60612-4861 |
| Second Address | Council Bluffs, IA 51503-4619 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/04/2015 |
| Last Update Date | 02/08/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.