MEDICARE: JOANNA BORKOWSKI 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	L2813	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220032539	OTHER	TX	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1710981188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA BORKOWSKI M.D.

Provider Business Mailing Address
First Line	:	201 WALLS DRIVE
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	77242-4007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 WALLS DR
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4008
Country	:	US
Telephone Number	:	817-429-0123
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/22/2011

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