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General NPI Number Information
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NPI Number | 1235100298
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Entity Type | Individual
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Provider Name | LOUIS JOHN BORUCKI MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 1411 N FLAGLER DRIVE STE 8000
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 561-833-7600
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Fax | 561-833-7644
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Provider Business Mailing Address
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Address Line | 1411 N FLAGLER DRIVE STE 8000
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 561-833-7600
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Fax | 561-833-7644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME29203
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License Number State | FL
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