Healthcare Provider Details

I. General information

NPI: 1467838441
Provider Name (Legal Business Name): MADHURA SUBHASH BORIKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LILE DR
LITTLE ROCK AR
72205-6217
US

IV. Provider business mailing address

10001 LILE DR
LITTLE ROCK AR
72205-6217
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-0500
  • Fax: 501-604-8758
Mailing address:
  • Phone: 718-866-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberE-13091
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: