Provider Demographics
NPI:1386615144
Name:BODMAN, MICHAEL JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BODMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21245 LORAIN RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2146
Mailing Address - Country:US
Mailing Address - Phone:440-356-1989
Mailing Address - Fax:440-356-5944
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:SUITE 115
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2146
Practice Address - Country:US
Practice Address - Phone:440-356-1989
Practice Address - Fax:440-356-5944
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003254213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341944827OtherAETNA
OH480033770OtherRAILROAD MEDICARE
OH000000210952OtherBLUE CROSS AND BLUE SHIELD
OH2250184Medicaid
OH480033770OtherRAILROAD MEDICARE
OH4045531Medicare ID - Type Unspecified
OH2250184Medicaid