Provider Demographics
NPI:1285673038
Name:BODA, MOHD I (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHD
Middle Name:I
Last Name:BODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3490 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2361
Mailing Address - Country:US
Mailing Address - Phone:816-554-7100
Mailing Address - Fax:816-478-0288
Practice Address - Street 1:3490 NE RALPH POWELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2361
Practice Address - Country:US
Practice Address - Phone:816-554-7100
Practice Address - Fax:816-478-0288
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200198790AMedicaid
MO205760713Medicaid
KS200556350BMedicaid
OK200198790AMedicaid
MOMA2082125Medicare PIN