=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205924446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BB BORKAR PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 BARRET AVE #301
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-581-0660
-----------------------------------------------------
Fax | 502-581-0960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 BARRET AVE #301
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-581-0660
-----------------------------------------------------
Fax | 502-581-0960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. BHAGWANT B BORKAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-581-0660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 18706
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------