MEDICARE: DR. MYRON A BODMAN DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	36-00-1747	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4800325161	OTHER	OH	RAILROAD MEDICARE

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	:	1316943970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRON A BODMAN DPM

Provider Business Mailing Address
First Line	:	21245 LORAIN RD
Second Line	:	STE 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 RD
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/17/2012

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