Healthcare Provider Details

I. General information

NPI: 1881637999
Provider Name (Legal Business Name): SARA M BODNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD MRI BUILDING, 2ND FLOOR
MIAMI BEACH FL
33140
US

IV. Provider business mailing address

4525 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-5201
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2194
  • Fax: 305-532-5241
Mailing address:
  • Phone: 312-857-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036.143570
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME69782
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME69782
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.143570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: