MEDICARE: MICHAEL JOHN BORER M.D.

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	207W00000X	Ophthalmology Physician	G12589	CA

General Provider Information

NPI Number	:	1558315390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHN BORER M.D.

Provider Business Mailing Address
First Line	:	14460 N CHURCH SQ
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3751
Country	:	US
Telephone Number	:	858-613-1808
Fax Number	:	858-613-1801

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE #210
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-760-4333
Fax Number	:	818-760-4335

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/09/2011

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