Individual
DR. EDIANA RESTIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE STE A501, GRAND RAPIDS, MI 49503-2560
(616) 391-6243
Mailing address
100 MICHIGAN ST NE STE A501, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4351046718
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2020
Last updated
06/15/2023
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