Individual
BORIS VIDRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 364-4200
Mailing address
621 E MEHRING WAY UNIT 1502, CINCINNATI, OH 45202-3530
(248) 227-4767
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301105813
MI
207LP3000X
Pediatric Anesthesiology Physician
Primary
4301105813
MI
Other
Enumeration date
07/08/2014
Last updated
07/10/2019
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