John Bodine, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601001693 Issued in MI

Practice address

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Phone

(248) 898-4021

Fax

(248) 898-1473

NPI assigned

Oct 30, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1457530230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-4021",
            "fax_number": "248-898-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-4021",
            "fax_number": "248-898-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODINE",
        "first_name": "JOHN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-30",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601001693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Sarah Blumenthal, PHARMD
• Susan Kim Blust, PT
• BM Healthcare PLLC
• Alyssa Boatman
• Erika London Bocknek, PHD, LMFT
• Body Mechanics Physical Therapy, PC
• Bodyspecific Inc.
• Douglas J Boersen, LMSW
• Mary Beth Boeson, CRNA
• Emily Marie Bogart

• Medical Physician Assistant in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.