Healthcare Provider Details

I. General information

NPI: 1679770267
Provider Name (Legal Business Name): ADEEL A BODLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SUN TEMPLE DR
MADISON AL
35758-5924
US

IV. Provider business mailing address

400 SUN TEMPLE DR STE D
MADISON AL
35758-5924
US

V. Phone/Fax

Practice location:
  • Phone: 256-774-5524
  • Fax: 256-774-5523
Mailing address:
  • Phone: 256-774-5524
  • Fax: 256-774-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD30833
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: