Bodner, Russell Jeffrey

Bodner, Russell Jeffrey is an individual health care provider with primary practice located at 2111 Midlands Ct , Sycamore IL 60178-3125. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Bodner, Russell Jeffrey can be contacted via phone (815) 758-0000.

Contact Information

Primary practice address
2111 Midlands Ct Sycamore IL 60178-3125
Phone: (815) 758-0000
Fax: (815) 756-7130
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 036-104076 Illinois

Profile Details

NPI number 1063527208
LBN Legal business name Bodner, Russell Jeffrey
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2006
Last updated Oct 1st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063527208 NPPES
Illinois Other 01915167 BLUE CROSS/BLUE SHIELD
Illinois Other 0359580001 BLUE CROSS/BLUE SHIELD
Illinois Other 200040517 BLUE CROSS/BLUE SHIELD
Illinois MEDICAID 036104076 BLUE CROSS/BLUE SHIELD
Illinois Other 066360 BLUE CROSS/BLUE SHIELD

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