Provider Demographics
NPI:1437716479
Name:ODABASIC, STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:ODABASIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37595 7 MILE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1003
Mailing Address - Country:US
Mailing Address - Phone:734-793-2470
Mailing Address - Fax:734-793-2471
Practice Address - Street 1:37595 7 MILE RD STE 340
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:734-793-2471
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2019016842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine