Individual
YAROSLAV DANIEL BODNAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.070456
IL
207R00000X
Internal Medicine Physician
2024-01939
NC
208000000X
Pediatrics Physician
036155975
IL
208000000X
Pediatrics Physician
125.070456
IL
208000000X
Pediatrics Physician
Primary
2024-01939
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.070456
TEMPORARY MEDICAL LICENSE
IL
Enumeration date
06/19/2017
Last updated
11/06/2024
Update your record
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