Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenneth A Bodziak, MD

Individual provider Nephrology Physician · NPI 1699790295

Kenneth A Bodziak, MD is a Nephrology in Worcester, Massachusetts. Graduated from University of Cincinnati College of Medicine in 1987, 39 years ago. Practices with Banner - University Super Specialists LLC, a 32-clinician group and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
39
Trained at
University of Cincinnati College of Medicine
Licensed in
MA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

55 Lake Ave N
Worcester, MA 01655-0002
Phone: (508) 334-1269
Fax: (774) 443-7827
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence 262575 (MA)

Record details

NPI number1699790295
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 13, 2006
Last updated in NPPESNovember 17, 2020
Certification dateNovember 17, 2020
Mailing addressPo Box 415348, Boston, MA 02241-5348

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEPHROLOGY
Medical schoolUNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduated 1987 (39 years in practice)
Group practice Banner - University Super Specialists Llc — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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