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NPI Code Detail

MEDICARE: MR. MICHAEL JOHN BORUCKI M.D.

MEDICARE: MR. MICHAEL JOHN BORUCKI M.D.
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
1207RI0200XInfectious Disease PhysicianG6777TX
2207R00000XInternal Medicine PhysicianG6777TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1756.061.354OTHERTXTPI-TEXAS PROVIDER ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194713230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOHN BORUCKI M.D.
Provider Business Mailing Address
First Line : 1600 PROVIDENCE DR
Second Line : FAMILY PRACTICE CENTER
City : WACO
State : TX
Zip : 76707-2261
Country : US
Telephone Number : 254-750-8200
Fax Number : 254-750-8383
Provider Business Practice Location Address
First Line : 1600 PROVIDENCE DR
Second Line : FAMILY PRACTICE CENTER
City : WACO
State : TX
Zip : 76707-2261
Country : US
Telephone Number : 254-750-8200
Fax Number : 254-750-8383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 01/14/2013

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