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Organization

PREMIUM PEDIATRICS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAN G. BODEANU MD (PHYSICIAN AND OWNER)
(270) 789-4788
Entity
Organization

Contact information

Practice address
307 E BROADWAY ST, CAMPBELLSVILLE, KY 42718-2003
(270) 789-4788
(270) 572-4227
Mailing address
307 E BROADWAY ST, CAMPBELLSVILLE, KY 42718-2003
(270) 789-4788
(270) 572-4227

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
50013851
PASSPORT
KY
05
64128457
KY
Enumeration date
11/28/2006
Last updated
08/11/2008
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