Individual
KENNETH A BODZIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-1269
(774) 443-7827
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
262575
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224247
UNISON
—
01
—
000000539531
ANTHEM
—
05
—
110104086A
—
MA
01
—
363368
WELLCARE
—
01
—
390007777
RAILROAD MEDICARE
OH
01
—
4504993
AETNA
OH
01
—
741798
BUCKEYE
—
Enumeration date
07/13/2006
Last updated
11/17/2020
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