Healthcare Provider Details

I. General information

NPI: 1841251378
Provider Name (Legal Business Name): BRITT MICHAEL BORDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 05/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N STETSON AVE
CHICAGO IL
60601-6710
US

IV. Provider business mailing address

PO BOX 308
FLOSSMOOR IL
60422-0308
US

V. Phone/Fax

Practice location:
  • Phone: 312-502-4255
  • Fax:
Mailing address:
  • Phone: 312-502-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036115105
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036115105
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036115105
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036115105
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: