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General NPI Number Information
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NPI Number | 1780849083
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Entity Type | Individual
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Provider Name | JOEL LEON BORGEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1969 N LINCOLN AVE APT G
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City | CHICAGO
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State | IL
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Zip | 60614-5403
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Country | US
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Telephone | 773-899-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 1969 N LINCOLN AVE APT G
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City | CHICAGO
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State | IL
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Zip | 60614-5403
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Country | US
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Telephone | 773-899-0204
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 125051558
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | D70300
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License Number State | MD
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