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Individual

BLAKE MICHAEL BODENDORFER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1 EDMUNDSON PL STE 500, COUNCIL BLUFFS, IA 51503-4619
(712) 323-5333
Mailing address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(312) 432-2351
(708) 409-5179

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036152051
IL

Other

Enumeration date
04/07/2015
Last updated
08/02/2021
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