Provider Demographics
NPI:1447665575
Name:BODEMANN, YVONNE MIYA (DO)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:MIYA
Last Name:BODEMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:CHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:835 E 18TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-825-4646
Practice Address - Fax:303-825-3215
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56311208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029133OtherKAISER COMMERCIAL NUMBER
CO9000148552Medicaid