Blake Michael Bodendorfer, M.D.
Orthopaedic Surgery, Sports Medicine in Council Bluffs, IA. Individual provider (NPI-1).
NPI number1083000905
StatusActive
Last updated in NPPESAug 2, 2021
Details
- NPI
- 1083000905
- Entity type
- Individual (NPI-1)
- Name
- Blake Michael Bodendorfer
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 7, 2015
- Certification date
- Aug 2, 2021
- Last updated
- Aug 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207XX0005X | Orthopaedic Surgery, Sports Medicine | 036152051 | IL | Yes |
Practice location
1 Edmundson Pl Ste 500Council Bluffs, IA 51503-4619
Phone 712-323-5333
Mailing address
1611 W Harrison St Ste 400Chicago, IL 60612-4861
Phone 312-432-2351 · Fax 708-409-5179
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.