Healthcare Provider Details

I. General information

NPI: 1831363886
Provider Name (Legal Business Name): BORKOWF AND BORKOVEC MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 NORTH LAKE DRIVE SUITE 500
MILWAUKEE WI
53211-4507
US

IV. Provider business mailing address

2350 NORTH LAKE DRIVE SUITE 500
MILWAUKEE WI
53211-4507
US

V. Phone/Fax

Practice location:
  • Phone: 414-289-9669
  • Fax: 414-289-9693
Mailing address:
  • Phone: 414-289-9669
  • Fax: 414-289-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27123
License Number StateWI

VIII. Authorized Official

Name: TERRE M BORKOVEC
Title or Position: OWNER
Credential: MD
Phone: 414-289-9668