Provider Demographics
NPI:1427057314
Name:BODINE-ZELLER, KRISTEN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BODINE-ZELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BODINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5700 MONROE ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2735
Mailing Address - Country:US
Mailing Address - Phone:419-843-8100
Mailing Address - Fax:419-841-4681
Practice Address - Street 1:5700 MONROE ST UNIT 203
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2735
Practice Address - Country:US
Practice Address - Phone:419-843-8100
Practice Address - Fax:419-841-4681
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2176729Medicaid
OH01-05187OtherUHC
OH2467797OtherAETNA
OH080161417OtherRRMC
OH03670OtherPARAMOUNT
OH000000141204OtherANTHEM
OH2176729Medicaid
OH080161417OtherRRMC