Individual
ENID VIDAL-RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8392 HOLLY RD, GRAND BLANC, MI 48439-1867
(810) 694-9903
(810) 695-6644
Mailing address
8392 HOLLY RD, GRAND BLANC, MI 48439-1867
(810) 694-9903
(810) 695-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301066781
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080B51127
BLUE CROSS BLUE SHIELD
MI
05
—
4189655
—
MI
Enumeration date
08/23/2006
Last updated
09/24/2014
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