Individual
DR. BRANDON CHARLES BODAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10945 N PORT WASHINGTON RD STE 201, MEQUON, WI 53092-5078
(262) 292-3151
Mailing address
10945 N PORT WASHINGTON RD STE 201, MEQUON, WI 53092-5078
(262) 292-3151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
61321
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063658
—
WI
Enumeration date
03/28/2012
Last updated
02/14/2025
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