Healthcare Provider Details

I. General information

NPI: 1831103605
Provider Name (Legal Business Name): RONALD J. BORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 10TH AVE STE 39
HIALEAH FL
33010-3766
US

IV. Provider business mailing address

5607 NW 27TH AVE STE 1
MIAMI FL
33142-2826
US

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 305-805-1700
  • Fax: 305-805-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME65114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: