Basic Information
| Provider Information | |||||||||
| NPI: | 1770534372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODEAU | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 29842 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00126385 | 01 | MN | RAILROAD MEDCIARE MN | OTHER | 0533448 | 05 | IA | MEDICAID | 32385300 | 05 | WI | MEDICAID | 794265600 | 05 | MN | MEDICAID | 108789 | 01 | MN | UCARE | OTHER | 4T045BO | 01 | MN | BLUE CROSS | OTHER | 22825 | 01 | MN | AMERICA'S PPO | OTHER | 300046433 | 01 | WI | RAILROAD MEDICARE WI | OTHER | HP12925 | 01 | MN | HEALTHPARTNERS | OTHER | 9253416 | 01 | MN | DAKOTA CARE | OTHER | 47Q34BO | 01 | MN | BLUE CROSS | OTHER | 1006999 | 01 | MN | PREFERRED ONE | OTHER | 232903 | 01 | MN | MIDLANDS CHOICE INC | OTHER |