# DR. STEFANO JOHN BORDOLI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1760648364
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 125051812 | IL | — |
| 2086S0129X | Vascular Surgery Physician | LL 33480 | SC | Yes |

## Other

- **Enumeration date:** 08/03/2008
- **Last updated:** 01/27/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1760648364 | NPI | MI |
| 05 | — | 1760648364 | — | MI |