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Individual
RUSSELL JEFFREY BODNER
Active
Individual
RUSSELL JEFFREY BODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-104076
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01915167
BLUE CROSS/BLUE SHIELD
IL
01
—
0359580001
DMERC
IL
05
—
036104076
—
IL
01
—
066360
HEALTH ALLIANCE
IL
01
—
200040517
RAILROAD MEDICARE
IL
Enumeration date
08/20/2006
Last updated
10/01/2020
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