Healthcare Provider Details

I. General information

NPI: 1942399209
Provider Name (Legal Business Name): DEBAROTI (TINA) MULLICK BORSCHEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

P O BOX 1000 DEPT 351
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-2362
  • Fax: 901-516-8254
Mailing address:
  • Phone: 901-758-9900
  • Fax: 901-752-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2006027157
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56669
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56669
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: