Individual
DR. KENNETH EDWARD BODEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
186 KIMEL PARK DR, SUITE 400, WINSTON SALEM, NC 27103-6946
(336) 277-2000
(336) 277-2050
Mailing address
PO BOX 751803, SUITE 400, CHARLOTTE, NC 28275-1803
(336) 277-2000
(336) 277-2050
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
2013-01642
NC
207RC0000X
Cardiovascular Disease Physician
MD046703L
PA
207UN0901X
Nuclear Cardiology Physician
MD046703L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012804190005
—
PA
01
—
024733E15
MEDICARE
PA
Enumeration date
09/06/2005
Last updated
11/15/2023
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