Provider Demographics
NPI:1144415845
Name:BIRGIT BODINE MD PA
Entity type:Organization
Organization Name:BIRGIT BODINE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRGIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BODINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:915-526-4851
Mailing Address - Street 1:PO BOX 511478
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1478
Mailing Address - Country:US
Mailing Address - Phone:915-526-4851
Mailing Address - Fax:941-575-8014
Practice Address - Street 1:10043 WINDING RIVER RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-1302
Practice Address - Country:US
Practice Address - Phone:915-526-4851
Practice Address - Fax:941-575-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH329Medicare PIN