Bordoli, Stefano John
Bordoli, Stefano John is an sole proprietor health care provider with primary practice located at 4069 Lake Dr Se Suite 312, Grand Rapids MI 49546-8816. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Bordoli, Stefano John can be contacted via phone (616) 267-8700.Contact Information
Primary practice address
4069 Lake Dr Se Suite 312
Grand Rapids MI 49546-8816
Phone: (616) 267-8700
Fax: (616) 267-8247
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 125051812 | Illinois |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | LL 33480 | South Carolina |
Profile Details
| NPI number | 1760648364 |
|---|---|
| LBN Legal business name | Bordoli, Stefano John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 3rd, 2008 |
| Last updated | Feb 26th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760648364 | NPPES |
| Michigan | Other | 1760648364 | NPI |
| Michigan | MEDICAID | 1760648364 | NPI |
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