Healthcare Provider Details

I. General information

NPI: 1285342303
Provider Name (Legal Business Name): MADISON ANNE BORGMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 INWOOD ROAD
DALLAS TX
75390-0014
US

IV. Provider business mailing address

1801 INWOOD ROAD
DALLAS TX
75390-0014
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-1482
  • Fax: 214-645-3301
Mailing address:
  • Phone: 214-645-1482
  • Fax: 214-645-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: