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General NPI Number Information
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NPI Number | 1457655136
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Entity Type | Organization
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Legal Business Name | JOHN E BODELL DO PC
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 2871 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-2476
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Country | US
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Telephone | 734-676-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 2871 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-2476
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Country | US
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Telephone | 734-676-3575
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Fax |
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Authorized Official
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Title or Position | NURSE ADMINISTRATOR
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Name | MS. JANET MARIE BODELL
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Credential | SFO,RN,MSH
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Telephone | 734-676-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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