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Individual

DR. WALTER BODJANAC

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
6316 W UNION HILLS DR STE 200, GLENDALE, AZ 85308-1001
(480) 905-8485
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
(419) 468-0522

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
34-00-5512-B
OH
208600000X
Surgery Physician
34-00-5512-B
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000141877
ANTHEM
OH
05
0161355
OH
01
1143537003
CIGNA
OH
01
2171126
AETNA GOLDEN
OH
01
5489782
AETNA MGD CHOICE
OH
01
91970
QUAL CHOICE
OH
Enumeration date
11/17/2005
Last updated
06/28/2024
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