Healthcare Provider Details

I. General information

NPI: 1619965969
Provider Name (Legal Business Name): STEPHEN ANTHONY BODNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 HOSPITAL DR NW STE 270
CORYDON IN
47112-2178
US

IV. Provider business mailing address

PO BOX 38
CORYDON IN
47112-0038
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4251
  • Fax: 812-738-7833
Mailing address:
  • Phone: 812-738-7830
  • Fax: 812-738-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01035411A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: