Provider Demographics
NPI:1316049729
Name:BODENHEIMER, CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:BODENHEIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:B
Other - Last Name:ALBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1333 MOURSUND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3405
Mailing Address - Country:US
Mailing Address - Phone:713-797-5248
Mailing Address - Fax:713-797-5241
Practice Address - Street 1:1333 MOURSUND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-797-5248
Practice Address - Fax:713-797-5241
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3917208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F68621Medicare UPIN
TX8J2203Medicare PIN