Healthcare Provider Details

I. General information

NPI: 1982399309
Provider Name (Legal Business Name): NATHANIEL BODE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6189 W JOHN L MODGLIN DR STE 101
GREENFIELD IN
46140-9364
US

IV. Provider business mailing address

6189 W JOHN L MODGLIN DR STE 101
GREENFIELD IN
46140-9364
US

V. Phone/Fax

Practice location:
  • Phone: 317-866-7300
  • Fax:
Mailing address:
  • Phone: 317-866-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02009216A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: