Provider Demographics
NPI:1568450831
Name:BODINE, BIRGIT (MD)
Entity Type:Individual
Prefix:DR
First Name:BIRGIT
Middle Name:
Last Name:BODINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511478
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1478
Mailing Address - Country:US
Mailing Address - Phone:915-526-4851
Mailing Address - Fax:941-575-8014
Practice Address - Street 1:10043 WINDING RIVER RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-1302
Practice Address - Country:US
Practice Address - Phone:915-526-4851
Practice Address - Fax:941-575-8014
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
U5818YMedicare PIN
FLU5818XMedicare PIN
FLH47051Medicare UPIN