Provider Demographics
NPI:1952483554
Name:BAKODY, PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:BAKODY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PARK ST
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1601
Mailing Address - Country:US
Mailing Address - Phone:515-720-3004
Mailing Address - Fax:515-243-2352
Practice Address - Street 1:615 PARK ST
Practice Address - Street 2:SUITE 1207
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1601
Practice Address - Country:US
Practice Address - Phone:515-720-3004
Practice Address - Fax:515-243-2352
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA015272085R0202X
KY027372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B58240Medicare UPIN