Individual
BRADLEY T BODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2800 WESTHILL DR, SUITE 200, WAUSAU, WI 54401-3771
(715) 843-1000
Mailing address
2800 WESTHILL DRIVE, SUITE 200, WAUSAU, WI 54402-3770
(715) 843-1000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1312-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41923000
—
WI
Enumeration date
05/17/2006
Last updated
12/15/2021
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