Healthcare Provider Details

I. General information

NPI: 1316474463
Provider Name (Legal Business Name): JULIE M BORKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2017
Last Update Date: 05/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY
SOUTHFIELD MI
48075-6501
US

IV. Provider business mailing address

12739 NADINE AVE
HUNTINGTON WOODS MI
48070-1445
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704297324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: