Healthcare Provider Details

I. General information

NPI: 1316180342
Provider Name (Legal Business Name): ALEKSEY I BORODYANSKIY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX BORODYANSKIY MD

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95TH ST
MIAMI FL
33150-2038
US

IV. Provider business mailing address

3801 NE 207TH ST APT 2502
AVENTURA FL
33180-3786
US

V. Phone/Fax

Practice location:
  • Phone: 305-710-9021
  • Fax: 888-958-0545
Mailing address:
  • Phone: 773-592-4174
  • Fax: 888-958-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036131257
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME146567
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME146567
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME146567
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME146567
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME146567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: