Healthcare Provider Details

I. General information

NPI: 1073669024
Provider Name (Legal Business Name): HARRY R BOROVIK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 6TH ST SUITE 102
TRAVERSE CITY MI
49684-2359
US

IV. Provider business mailing address

1221 6TH STREET SUITE 102 MUNSON PROFESSIONAL BLDG
TRAVERSE CITY MI
49684
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-3223
  • Fax: 231-935-3221
Mailing address:
  • Phone: 231-935-3223
  • Fax: 231-935-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberHB052140
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number0B80310
License Number StateMI

VIII. Authorized Official

Name: HARRY R BOROVIK
Title or Position: PHYSICIAN
Credential: MD
Phone: 231-935-3223