Provider Demographics
NPI:1417917725
Name:BODJANAC, STEPHEN M (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:BODJANAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8143
Mailing Address - Fax:330-665-1289
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:SUITE 215
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-665-8143
Practice Address - Fax:330-665-1289
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherMEDICAID GROUP #
OH1841239274OtherPPG GROUP NPI #
OH9338635OtherMEDICARE GROUP #
OH1023301025OtherPRACTICE TYPE 2 NPI #
OH2127657Medicaid
OHP00469259OtherRAILROAD MEDICARE #
OH1841239274OtherPPG GROUP NPI #
OHG99586Medicare UPIN