Provider Demographics
NPI:1770534372
Name:BODEAU, GEOFFREY R (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:R
Last Name:BODEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 KENNEY PL
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1427
Mailing Address - Country:US
Mailing Address - Phone:952-947-9445
Mailing Address - Fax:
Practice Address - Street 1:6608 KENNEY PL
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1427
Practice Address - Country:US
Practice Address - Phone:952-947-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN298422085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4T045BOOtherBLUE CROSS
MNHP12925OtherHEALTHPARTNERS
MN108789OtherUCARE
IA0533448Medicaid
WI300046433OtherRAILROAD MEDICARE WI
MN22825OtherAMERICA'S PPO
WI32385300Medicaid
MN47Q34BOOtherBLUE CROSS
MNP00126385OtherRAILROAD MEDCIARE MN
MN232903OtherMIDLANDS CHOICE INC
MN794265600Medicaid
MN1006999OtherPREFERRED ONE
MN9253416OtherDAKOTA CARE
MNP00126385OtherRAILROAD MEDCIARE MN
MN232903OtherMIDLANDS CHOICE INC
IA0533448Medicaid
MN300000716Medicare PIN
WI001156135Medicare PIN