Healthcare Provider Details

I. General information

NPI: 1568242055
Provider Name (Legal Business Name): BRITT MICHAEL BORDEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FOUNDRY DR STE 1209
WEST LAFAYETTE IN
47906-3445
US

IV. Provider business mailing address

101 FOUNDRY DR STE 1200
WEST LAFAYETTE IN
47906-3446
US

V. Phone/Fax

Practice location:
  • Phone: 765-412-5180
  • Fax:
Mailing address:
  • Phone: 765-412-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITT MICHAEL BORDEN
Title or Position: OWNER
Credential: MD
Phone: 708-846-8888