DR. STEFANO JOHN BORDOLI (NPI# 1760648364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760648364 |
| Entity Type | Individual |
| Full Name | DR. STEFANO JOHN BORDOLI |
| Credential | M.D. |
| Practice Address |
4069 Lake Dr Se Suite 312 Grand Rapids MI 49546-8816 |
| Mailing Address |
100 Michigan St Ne Mc 845 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6162678700 |
| Practice Fax Number | 6162678247 |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2013-08-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 125051812 | IL | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
LL 33480 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1760648364 | 05 | |
| MI | NPI | 1760648364 | 01 |
| Street Address |
4069 LAKE DR SE SUITE 312 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-8816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811983000 | Spectrum Health | Durable Medical Equipment & Medical Supplies | 4069 Lake Dr Se, Suite 210, Grand Rapids, MI 49546-8816 | 2005-09-22 |
| 1184070807 | Danielle Wentworth | Audiologist | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2016-05-12 |
| 1205253424 | Elizabeth House | Physician Assistant | 4069 Lake Dr Se, Suite 312, Grand Rapids, MI 49546-8816 | 2014-03-26 |
| 1043655780 | Spectrum Health Primary Care Partners | Nutritionist | 4069 Lake Dr Se, Ste. 315, Grand Rapids, MI 49546-8816 | 2013-05-08 |
| 1790025898 | George Torao Sugiyama | Surgery | 4069 Lake Dr Se, Suite 312, Grand Rapids, MI 49546-8816 | 2013-02-26 |
| 1639442791 | Debra Ann West | Audiologist | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2012-02-20 |
| 1982976924 | Ashley Lucas | Physician Assistant | 4069 Lake Dr Se, Suite 117, Grand Rapids, MI 49546-8816 | 2012-02-07 |
| 1861762122 | Carley Therese Flegler | Physician Assistant | 4069 Lake Dr Se, Suite 313, Grand Rapids, MI 49546-8816 | 2012-01-04 |
| 1013227156 | Spectrum Health Primary Care Partners | Durable Medical Equipment & Medical Supplies | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2010-10-07 |
| 1285944322 | Spectrum Health Primary Care Partners | Durable Medical Equipment & Medical Supplies | 4069 Lake Dr Se, Suite 314, Grand Rapids, MI 49546-8816 | 2010-10-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558326009 | Lee A Rea | Surgery | 4047 Saladin Dr Se, Grand Rapids, MI 49546-6249 | 2006-04-19 |
| 1467013698 | Jake Anthony Nicholson | Surgery | 100 Michigan St Ne Ste A501, Grand Rapids, MI 49503-2560 | 2019-06-27 |
| 1265927438 | Ivan Noffsker | Surgery | 221 Michigan St Ne Ste 402, Grand Rapids, MI 49503-2538 | 2018-06-28 |
| 1427578004 | Kush Sharma | Surgery | 221 Michigan St Ne Ste 402, Grand Rapids, MI 49503-2538 | 2017-06-23 |
| 1154772515 | Joyce Lu | Surgery | 221 Michigan St Ne, Suite 200a, Grand Rapids, MI 49503-2543 | 2016-06-28 |
| 1790025898 | George Torao Sugiyama | Surgery | 4069 Lake Dr Se, Suite 312, Grand Rapids, MI 49546-8816 | 2013-02-26 |
| 1194088120 | Lindsey Marie Korepta | Surgery | 221 Michigan St Ne, Suite 200a, Grand Rapids, MI 49503-2543 | 2012-06-25 |
| 1578859542 | Michelle Kosovec | Surgery | 310 Lafayette Ave Se, Suite 301, Grand Rapids, MI 49503-4693 | 2011-06-28 |
| 1700052230 | Michigan Medical PC | Surgery | 2093 Health Dr Sw, Grand Rapids, MI 49519-9691 | 2008-05-05 |
| 1306018528 | Michigan Medical Patient Care | Surgery | 4085 Burton St Se, Grand Rapids, MI 49546-2444 | 2008-03-27 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49546 |
Please comment or provide details below to improve the information on DR. STEFANO JOHN BORDOLI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.