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General NPI Number Information
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NPI Number | 1831445295
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Entity Type | Individual
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Provider Name | AMY BODNARCHUK M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 3890 CHARLEVOIX RD STE 307
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City | PETOSKEY
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State | MI
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Zip | 49770-8422
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Country | US
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Telephone | 231-360-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 3890 CHARLEVOIX RD STE 307
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City | PETOSKEY
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State | MI
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Zip | 49770-8422
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Country | US
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Telephone | 231-360-2496
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.128368
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 251644
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301510582
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License Number State | MI
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