Healthcare Provider Details

I. General information

NPI: 1316938137
Provider Name (Legal Business Name): JOSEPH SAMUEL BORUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S GREEN RD SUITE 035
SOUTH EUCLID OH
44121-4128
US

IV. Provider business mailing address

1611 SOUTH GREEN ROAD SUITE 035
SOUTH EUCLID OH
44121
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-3800
  • Fax:
Mailing address:
  • Phone: 216-382-3800
  • Fax: 216-381-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: