Amy Bodnarchuk, M.D.
Individual provider Active NPI Internal Medicine Physician · Petoskey, MI
NPI 1831445295 · NPPES record last updated Dec 31, 2024
Key facts
- NPI
- 1831445295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 4301510582 (MI)
- Practice address
- 3890 Charlevoix Rd Ste 307
Petoskey, MI 49770-8422 - Phone
- (231) 360-2496
- NPI assigned
- Aug 2, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.128368 | OH | MD | Family Medicine Physician |
| 4301510582 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| This Osteopathic Life, PLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35.128368 | OH | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 251644 | MA | |
| Internal Medicine Physician | 207R00000X | 4301510582 | MI | Yes |
Addresses
Primary practice location
3890 Charlevoix Rd Ste 307
Petoskey, MI 49770-8422
Mailing address
3890 Charlevoix Rd Ste 307
Petoskey, MI 49770-8422
Phone (231) 360-2496
Other practice location 1
818 Red Dr Ste 100
Traverse City, MI 49684-4729
Phone (231) 333-1331
Other providers in Petoskey, MI
- Mark James Bielaczyc
- Sue Bissell I
- Thomas Richard Biziorek
- Paul D Blanchard
- Keely Marie Blosh
- Laura Davis Bogner
- Timothy Ivan Bondy
- Laurie Anne Bonnington
- Katie Elizabeth Boonie
- Lawrence Paul Borrusch
All providers in Petoskey, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.