Healthcare Provider Details

I. General information

NPI: 1407941255
Provider Name (Legal Business Name): CARY J BORTNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD STE F107
DELRAY BEACH FL
33445-6506
US

IV. Provider business mailing address

4800 LINTON BLVD STE 107
DELRAY BEACH FL
33445-6584
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-5660
  • Fax: 561-498-0753
Mailing address:
  • Phone: 561-498-5660
  • Fax: 561-498-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036066875
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME138841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: