MEDICARE: SARA M BODNER MD

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	036.143570	IL
2	2084P0800X	Psychiatry Physician	ME69782	FL
3	2084P0805X	Geriatric Psychiatry Physician	ME69782	FL
4	2084P0800X	Psychiatry Physician	036.143570	IL

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	:	1881637999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA M BODNER MD

Provider Business Mailing Address
First Line	:	4525 N RAVENSWOOD AVE
Second Line	:	STE 201
City	:	CHICAGO
State	:	IL
Zip	:	60640-5201
Country	:	US
Telephone Number	:	312-857-8794
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 ALTON RD
Second Line	:	MRI BUILDING, 2ND FLOOR
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140
Country	:	US
Telephone Number	:	305-674-2194
Fax Number	:	305-532-5241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/01/2019

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Directions to “ SARA M BODNER MD” Practice Location

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