Healthcare Provider Details

I. General information

NPI: 1417934605
Provider Name (Legal Business Name): WILLIAM D BORKON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W LAKE ST
FRIENDSHIP WI
53934-9699
US

IV. Provider business mailing address

402 W LAKE ST
FRIENDSHIP WI
53934-9699
US

V. Phone/Fax

Practice location:
  • Phone: 608-339-3331
  • Fax:
Mailing address:
  • Phone: 608-339-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25147
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number67361-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: