MEDICARE: STEPHEN LAWRENCE BORODKIN 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	2084P0800X	Psychiatry Physician	25516	AZ
2	2084P0800X	Psychiatry Physician	11357	NV

General Provider Information

NPI Number	:	1770574857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN LAWRENCE BORODKIN M.D.

Provider Business Mailing Address
First Line	:	4776 E GUADALUPE RD
Second Line	:	APT #3084
City	:	GILBERT
State	:	AZ
Zip	:	85234-7501
Country	:	US
Telephone Number	:	602-955-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 EAST BROADWAY ROAD
Second Line	:	SUITE 240
City	:	TEMPE
State	:	AZ
Zip	:	85282
Country	:	US
Telephone Number	:	480-929-5100
Fax Number	:	480-731-1066

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	12/14/2009

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