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General NPI Number Information
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NPI Number | 1982818506
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Entity Type | Individual
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Provider Name | KEVIN L. BORST DO
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 14601 DETROIT AVE STE 540
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City | LAKEWOOD
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State | OH
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Zip | 44107-4251
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Country | US
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Telephone | 216-529-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 TILLMAN AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-2266
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Country | US
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Telephone |
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 34009832
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License Number State | OH
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