Basic Information
| Provider Information | |||||||||
| NPI: | 1417343575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODE | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604358200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157257133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604358200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157257133 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01083253A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 1417343575 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036.145780 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A170445 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036145780 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.