Individual
DR. STEFANO JOHN BORDOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
275 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2531
(616) 267-8700
(616) 267-8247
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125051812
IL
2086S0129X
Vascular Surgery Physician
Primary
LL 33480
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760648364
NPI
MI
05
—
1760648364
—
MI
Enumeration date
08/03/2008
Last updated
01/27/2025
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