MEDICARE: CASSANDRA BODUCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	S9106	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083177497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA BODUCH MD

Provider Business Mailing Address
First Line	:	2101 EVERGREEN DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-9504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 MEDICAL CENTER DR # 3B
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-1886
Country	:	US
Telephone Number	:	346-385-2775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	03/16/2026

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