Individual
KIMBERLY ANNE BODDICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-3443
Mailing address
400 E 3RD ST, SSB-5, DULUTH, MN 55805-1951
(218) 786-3146
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
16931
ND
207RC0000X
Cardiovascular Disease Physician
Primary
47480
MN
207RC0000X
Cardiovascular Disease Physician
47894-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
933138700
—
MN
Enumeration date
06/05/2006
Last updated
12/09/2020
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