Healthcare Provider Details

I. General information

NPI: 1326248543
Provider Name (Legal Business Name): ANGALA BORDERS-ROBINSON DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E MAIN ST
OWOSSO MI
48867-3140
US

IV. Provider business mailing address

503 E MAIN ST
OWOSSO MI
48867-3140
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-1390
  • Fax:
Mailing address:
  • Phone: 989-723-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101011356
License Number StateMI

VIII. Authorized Official

Name: ANGALA BORDERS-ROBINSON
Title or Position: OWNER
Credential: DO
Phone: 989-723-1390