MEDICARE: UPTOWN DERMATOLOGISTS OF BIRMINGHAM, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	4301092800	MI

General Provider Information

NPI Number	:	1184098675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN DERMATOLOGISTS OF BIRMINGHAM, PLLC

Provider Business Mailing Address
First Line	:	1459 CHESAPEAKE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-4526
Country	:	US
Telephone Number	:	248-225-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	35046 WOODWARD AVE
Second Line	:	SUITE L14
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-0964
Country	:	US
Telephone Number	:	248-225-6791
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	DR. MICHAEL BORKIN
Credential	:
Telephone Number	:	248-225-6791

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/23/2015

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