MEDICARE: LOUIS JOHN BORUCKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME29203	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235100298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS JOHN BORUCKI MD

Provider Business Mailing Address
First Line	:	1411 N FLAGLER DRIVE
Second Line	:	STE 8000
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401
Country	:	US
Telephone Number	:	561-833-7600
Fax Number	:	561-833-7644

Provider Business Practice Location Address
First Line	:	1411 N FLAGLER DRIVE
Second Line	:	STE 8000
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401
Country	:	US
Telephone Number	:	561-833-7600
Fax Number	:	561-833-7644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/09/2012

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Directions to “ LOUIS JOHN BORUCKI MD” Practice Location

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