Individual
BOHDAN E BODLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1190 NW 95TH ST, SUITE 204, MIAMI, FL 33150-2063
(305) 836-8410
(305) 836-9727
Mailing address
209 NE 95TH ST, SUITE 3, MIAMI SHORES, FL 33138-2745
(305) 836-8410
(305) 836-9727
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME53356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048766000
—
FL
01
—
07671
BLUE CROSS BLUE SHIELD
FL
01
—
0969598001
CIGNA
FL
01
—
112105A
HUMANA
FL
01
—
3592
NHP
FL
Enumeration date
11/22/2006
Last updated
10/13/2015
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