Healthcare Provider Details

I. General information

NPI: 1952236762
Provider Name (Legal Business Name): MICHAEL DEAN BORIE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W SAGINAW ST
SAINT LOUIS MI
48880-1437
US

IV. Provider business mailing address

323 W SAGINAW ST
SAINT LOUIS MI
48880-1437
US

V. Phone/Fax

Practice location:
  • Phone: 989-763-0255
  • Fax:
Mailing address:
  • Phone: 989-763-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: