Healthcare Provider Details

I. General information

NPI: 1770937658
Provider Name (Legal Business Name): JULIA BODNYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE ATTENTION M/C 2030
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

1725 W HARRISON ST STE 885
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 847-312-6559
  • Fax:
Mailing address:
  • Phone: 312-942-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.068534
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036151960
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036151960
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: