Provider Demographics
NPI:1619972999
Name:BODE, DAWN M (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BODE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:EVERHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:3900 28TH AVENUE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5536
Practice Address - Country:US
Practice Address - Phone:309-281-6000
Practice Address - Fax:309-281-6009
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0099085207Q00000X
IL036099085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01E8OtherJOHN DEERE HEALTH PLAN
4796890019OtherDMERC
IA91332OtherWELLMARK BC/BS
20206OtherIOWA HEALTH SOLUTIONS
IL036099085Medicaid
048510OtherHEALTH ALLIANCE
IL036099085Medicaid
20206OtherIOWA HEALTH SOLUTIONS