Provider Demographics
NPI:1306948922
Name:BODEANU, DAN GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:GEORGE
Last Name:BODEANU
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 1:307 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-2003
Mailing Address - Country:US
Mailing Address - Phone:270-789-4788
Mailing Address - Fax:270-572-4227
Practice Address - Street 1:307 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2003
Practice Address - Country:US
Practice Address - Phone:270-789-4788
Practice Address - Fax:270-572-4227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP 732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics