MEDICARE: DR BODMAN PODIATRY ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	36001747	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215008735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BODMAN PODIATRY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	21245 LORAIN ROAD
Second Line	:	SUITE 115
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-2140
Country	:	US
Telephone Number	:	440-356-1989
Fax Number	:	440-356-5944

Provider Business Practice Location Address
First Line	:	21245 LORAIN ROAD
Second Line	:	SUITE 115
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-2140
Country	:	US
Telephone Number	:	440-356-1989
Fax Number	:	440-356-5944

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	MICHAEL JAMES BODMAN
Credential	:	DPM
Telephone Number	:	440-356-1989

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/17/2020

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