Individual
KIRK JON BODACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 N MICHIGAN ST FL 1, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
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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