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General NPI Number Information
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NPI Number | 1669723573
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Entity Type | Individual
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Provider Name | ALLA BODNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 15 COMMERCE DR STE 113
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City | GRAYSLAKE
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State | IL
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Zip | 60030-7807
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Country | US
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Telephone | 847-231-4130
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Fax | 847-231-5303
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Provider Business Mailing Address
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Address Line | 1928 MONROE AVE
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City | GLENVIEW
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State | IL
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Zip | 60025-1708
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Country | US
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Telephone |
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036.131250
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License Number State | IL
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