MEDICARE: DR. STANLEY BORG D.O.

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	207Q00000X	Family Medicine Physician	036110069	IL

General Provider Information

NPI Number	:	1225205115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY BORG D.O.

Provider Business Mailing Address
First Line	:	222 N COLUMBUS DR
Second Line	:	#4703
City	:	CHICAGO
State	:	IL
Zip	:	60601-7810
Country	:	US
Telephone Number	:	312-856-0038
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 N COLUMBUS DR
Second Line	:	#4703
City	:	CHICAGO
State	:	IL
Zip	:	60601-7810
Country	:	US
Telephone Number	:	312-856-0038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2008
Last Update Date	:	05/11/2008

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