Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 36003254 | OH |
NPI | 1386615144 |
---|---|
Provider Name | Dr. Michael James Bodman |
First Address | Fairview Park, OH 44126-2146 |
Second Address | Fairview Park, OH 44126-2146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 17/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000210952 | BLUE CROSS AND BLUE SHIELD (01) | OH |
2250184 | (05) | OH |
341944827 | AETNA (01) | OH |
480033770 | RAILROAD MEDICARE (01) | OH |
U84422 | (02) | OH |