Provider Demographics
NPI:1215008735
Name:DR BODMAN PODIATRY ASSOCIATES INC
Entity Type:Organization
Organization Name:DR BODMAN PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-356-1989
Mailing Address - Street 1:21245 LORAIN ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2140
Mailing Address - Country:US
Mailing Address - Phone:440-356-1989
Mailing Address - Fax:440-356-5944
Practice Address - Street 1:21245 LORAIN ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2140
Practice Address - Country:US
Practice Address - Phone:440-356-1989
Practice Address - Fax:440-356-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2250237Medicaid
OH9315031Medicare PIN
OH2250237Medicaid