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General NPI Number Information
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NPI Number | 1417917725
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Entity Type | Individual
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Provider Name | STEPHEN M BODJANAC D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 4125 MEDINA RD SUITE 215
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City | AKRON
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State | OH
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Zip | 44333-2483
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Country | US
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Telephone | 330-665-8143
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Fax | 330-665-1289
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Provider Business Mailing Address
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Address Line | 4125 MEDINA RD SUITE 215
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City | AKRON
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State | OH
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Zip | 44333-2483
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Country | US
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Telephone | 330-665-8143
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Fax | 330-665-1289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34006963
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License Number State | OH
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