Provider Demographics
NPI:1730185646
Name:BODE, ERNEST G JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:G
Last Name:BODE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-291-4290
Mailing Address - Fax:419-479-3263
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3846
Practice Address - Country:US
Practice Address - Phone:419-291-2200
Practice Address - Fax:419-479-3298
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35059876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00716OtherNATIONWIDE
MI142191OtherCARE CHOICES
MI4215933Medicaid
OH0802082Medicaid
OH4121861OtherAETNA
OH344428256OtherEMERALD
MI12801OtherHPM
MI142191OtherPRIORITY
OH344428256062OtherCARESOURCES
OH000000190757OtherANTHEM BC/BS
OH01040OtherPARAMOUNT PROVIDER NUMBER
OH1613014002OtherCIGNA
OH344428256OtherEMERALD
MI142191OtherCARE CHOICES
OH110209977Medicare PIN