Healthcare Provider Details

I. General information

NPI: 1548285299
Provider Name (Legal Business Name): FLOR L. BORRERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 CLYDE PARK AVE SW STE. 4
WYOMING MI
49509-4095
US

IV. Provider business mailing address

3637 CLYDE PARK AVE SW STE. 4
WYOMING MI
49509-4095
US

V. Phone/Fax

Practice location:
  • Phone: 616-808-3265
  • Fax: 616-726-7019
Mailing address:
  • Phone: 616-808-3265
  • Fax: 616-726-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301066741
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: