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General NPI Number Information
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NPI Number | 1386615144
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BODMAN DPM
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 21245 LORAIN RD SUITE 115
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2146
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Country | US
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Telephone | 440-356-1989
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Fax | 440-356-5944
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Provider Business Mailing Address
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Address Line | 21245 LORAIN RD SUITE 115
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2146
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Country | US
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Telephone | 440-356-1989
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Fax | 440-356-5944
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 36003254
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License Number State | OH
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