# STEPHEN M BODJANAC

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1417917725
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 34006963 | OH | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 07/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1023301025 | PRACTICE TYPE 2 NPI \# | OH |
| 01 | — | 1841239274 | PPG GROUP NPI \# | OH |
| 05 | — | 2127657 | — | OH |
| 01 | — | 2551671 | MEDICAID GROUP \# | OH |
| 01 | — | 9338635 | MEDICARE GROUP \# | OH |
| 01 | — | P00469259 | RAILROAD MEDICARE \# | OH |