Individual
SALLY BODENSTEINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
406 N 1ST ST, VINCENNES, IN 47591-1340
(812) 882-1106
(812) 885-2758
Mailing address
406 N 1ST ST, VINCENNES, IN 47591-1340
(812) 882-1106
(812) 885-2758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01074304A
IN
208D00000X
General Practice Physician
MD2008-0602
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000898810
ANTHEM
IN
01
—
01074304A
INDIANA LICENSE
IN
05
—
201260890
—
IN
01
—
258190
MEDICARE GROUP
IN
Enumeration date
10/16/2007
Last updated
05/21/2015
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