BRADLEY T BODNER (NPI# 1093767808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093767808 |
| Entity Type | Individual |
| Full Name | BRADLEY T BODNER |
| Credential | PA-C |
| Practice Address |
2800 Westhill Dr Suite 200 Wausau WI 54401-3771 |
| Mailing Address |
2800 Westhill Drive Suite 200 Wausau WI 54402-3770 |
| Practice Telephone | 7158431000 |
| Mailing Telephone | 7158431000 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-04-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1312-023 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 41923000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366614406 | Bradley A Bodner | Physical Medicine & Rehabilitation | 710 Tennent Rd, Manalapan, NJ 07726-3161 | 2008-03-28 |
| Street Address |
2800 WESTHILL DR SUITE 200 |
| City | WAUSAU |
| State | WI |
| Zip Code | 54401-3771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316917008 | Associates In Pathology, S.c. | Clinical Medical Laboratory | 2800 Westhill Dr, Suite 208, Wausau, WI 54401-3771 | 2006-01-25 |
| 1548545189 | Emmanuel Esianor | Physician Assistant | 2800 Westhill Dr, Ste 200, Wausau, WI 54401-3771 | 2011-10-14 |
| 1073727277 | Spine & Brain Group Sc | Clinic/Center | 2800 Westhill Dr, Suite 200, Wausau, WI 54401-3771 | 2007-05-09 |
| 1861547754 | Cherry Tree Dental, LLC | Dentist | 2800 Westhill Dr, S-104, Wausau, WI 54401-3771 | 2007-01-24 |
| 1114976289 | Terence R. Lichtor | Neurological Surgery | 2800 Westhill Dr, Ste 200, Wausau, WI 54401-3771 | 2006-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
| 1376161976 | Family Foot and Ankle Clinic LLC | Podiatrist | 1901 Westwood Boulevard, Wausau, WI 54401 | 2020-07-09 |
| 1336701895 | Amy Kluetz | Counselor | 3000 Westhill Drive, Suite 100, Wausau, WI 54401 | 2019-07-05 |
| 1437640877 | Joseph T Fitz | Student in an Organized Health Care Education/Training Program | Aspirus Wausau Family Medicine, 425 Wind Ridge Drive, Wausau, WI 54401 | 2018-05-22 |
| 1699293241 | Amanda Nedd | Dietitian, Registered | 425 Pine Ridge Boulevard Suite 220 C, Wausau, WI 54401 | 2017-09-05 |
| 1396287447 | Dee Cha | Nurse Anesthetist, Certified Registered | 4851 Rachel Ln Apt 5, Wausau, WI 54401 | 2016-11-07 |
| 1013389618 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 2727 Plaza Dr., Wausau, WI 54401 | 2015-10-22 |
| 1881091163 | Judy Lao | Dental Hygienist | 413 North 17th Avenue, Wausau, WI 54401 | 2014-12-02 |
| 1295012011 | Allison Waraksa | Pharmacist | 504 S. 17th Ave, Wausau, WI 54401 | 2011-11-08 |
| 1881974053 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 504 S 17th Ave, Wausau, WI 54401 | 2011-08-19 |
| Find all providers in zip 54401 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679573463 | David Albert Nash | Physician Assistant | 425 Pine Ridge Blvd, Ste 209, Wausau, WI 54401-4123 | 2005-07-22 |
| 1154816437 | Anthony Vincent Hull | Physician Assistant | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2018-06-28 |
| 1922536218 | Kimberly Marie Kuphal | Physician Assistant | 425 Pine Ridge Blvd Ste 209, Wausau, WI 54401-4123 | 2017-05-31 |
| 1144249210 | Robert E Kollpainter | Physician Assistant | 425 Pine Ridge Blvd, Suite 209, Wausau, WI 54401 | 2006-07-19 |
| 1861446114 | Susan C Brown | Physician Assistant | 3200 Westhill Dr Ste 201, Wausau, WI 54401-4707 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821612045 | Cassidy Renee Thomas | Physician Assistant | 1111 Delafield St Ste 209, Waukesha, WI 53188-3403 | 2020-06-03 |
| 1982056768 | Luke Harbers | Physician Assistant | 6226 Bankers Rd Ste 11, Mount Pleasant, WI 53403-9799 | 2016-07-06 |
| 1093085664 | Abraham David Pacheco | Physician Assistant | 3246 S 35th St, Milwaukee, WI 53215-4156 | 2012-01-12 |
| 1346577954 | Darren Rosser | Physician Assistant | 2931 S 108th St, West Allis, WI 53227-3519 | 2009-11-03 |
| 1033359401 | Matthew S. Bay | Physician Assistant | 1818 N. Meade St Suite 240 West, Fox Valley Surgical Associates, Appleton, WI 54911-3496 | 2009-02-25 |
| 1265657068 | Surgical and Rehab Services Inc | Physician Assistant | E4051 Steven Way, Spring Green, WI 53588-9271 | 2007-04-16 |
| 1992844385 | Jill Ann Schumacher | Physician Assistant | 2265 90th St, Eau Claire, WI 54703-0181 | 2007-02-05 |
| 1609915073 | Brian Felix Robinson | Physician Assistant | S725 Turner Valley Rd, Mondovi, WI 54755-8331 | 2007-02-05 |
| 1124176383 | William Henry Price | Physician Assistant | 4819 5th Ave, Unit 2, Kenosha, WI 53140-2924 | 2007-01-06 |
| 1619032919 | Michael R Depew | Physician Assistant | 1650 S. 41st St., Lakeshore Orthopedics, Manitowoc, WI 54220 | 2006-12-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.