| Doctor Name: | DR. MYRON A BODMAN |
| NPI Number: | 1316943970 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 36-00-1747 |
| Business Practice Address: | 21245 Lorain Rd Suite 115 Fairview Park, OH - 441262140 |
| Business Phone Number: | 4403561989 |
| Business Fax Number: | 4403565944 |
| Mailing Address: | 21245 Lorain Rd, Ste 115 FAIRVIEW PARK |
| State: | OH |
| Postal Code: | 441262140 |
| Phone Number: | 4403561989 |
| Fax Number: | 4403565944 |
| NPI Enumeration Date: | 06/28/2005 |
| NPI Last Update Date: | 09/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 36-00-1747 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |