Healthcare Provider Details

I. General information

NPI: 1063440675
Provider Name (Legal Business Name): MADELINE BORHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2520
  • Fax: 206-386-3180
Mailing address:
  • Phone: 208-625-6900
  • Fax: 208-625-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60131031
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5441
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMC0677
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: