Healthcare Provider Details

I. General information

NPI: 1679376065
Provider Name (Legal Business Name): MAINE FOOT AND ANKLE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BRIGHTON AVE
PORTLAND ME
04102-2373
US

IV. Provider business mailing address

619 BRIGHTON AVE
PORTLAND ME
04102-2373
US

V. Phone/Fax

Practice location:
  • Phone: 207-521-6107
  • Fax:
Mailing address:
  • Phone: 207-910-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JULES B BODO
Title or Position: OWNNER/PHYSICIAN
Credential: DPM
Phone: 207-521-6107