Provider Demographics
NPI:1164475729
Name:BODNAR, DAWN M (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BODNAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-398-5880
Practice Address - Fax:402-398-6716
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22001207RC0000X
IA36044207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE31027OtherBLUE CROSS BLUE SHIELD
IA23911OtherWELLMARK
IA3557975Medicaid
IA23911OtherWELLMARK
NE31027OtherBLUE CROSS BLUE SHIELD
IAI17514Medicare ID - Type Unspecified
P00335779Medicare ID - Type UnspecifiedRAILROAD