Healthcare Provider Details

I. General information

NPI: 1083861769
Provider Name (Legal Business Name): BORO SKORIC ACA, AUDIOPROSTHOLOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5462 STATE ST
SAGINAW MI
48603-3678
US

IV. Provider business mailing address

5462 STATE ST
SAGINAW MI
48603-3678
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-7620
  • Fax: 989-793-2044
Mailing address:
  • Phone: 989-793-7620
  • Fax: 989-793-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501001976
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: