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General NPI Number Information
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NPI Number | 1659342152
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Entity Type | Individual
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Provider Name | MICHAEL D BORK DO
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 2333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-4668
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Country | US
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Telephone | 734-246-8895
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Fax | 734-324-3404
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Provider Business Mailing Address
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Address Line | 1640 FORT STREET SUITE D ATTN DENISE
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City | TRENTON
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State | MI
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Zip | 48183
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Country | US
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Telephone | 734-391-3057
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Fax | 734-391-3052
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101010520
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 5101010520
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License Number State | MI
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