Healthcare Provider Details

I. General information

NPI: 1467452235
Provider Name (Legal Business Name): MICHAEL FREITAS BORGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E. MARCH LN. STE 360
STOCKTON CA
95210-6675
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-951-1178
  • Fax: 916-733-6985
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG72319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG72319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: