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Individual
KIRK JON BODACH
Active
Individual
KIRK JON BODACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01065817A
IN
208M00000X
Hospitalist Physician
Primary
01065817A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000720320
BCBS MEMORIAL HOSPITALIST GROUP
IN
05
—
200986910
—
IN
01
—
M400050759
MEDICARE PTAN
IN
01
—
P01050896
RR MEDICARE
IN
Enumeration date
07/05/2007
Last updated
03/30/2026
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