MEDICARE: MR. MATTHEW MICHAEL BORKOVICH MD

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	207RI0011X	Interventional Cardiology Physician	14202169-1205	UT

General Provider Information

NPI Number	:	1518492420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW MICHAEL BORKOVICH MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N 500 E STE 320
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2462
Country	:	US
Telephone Number	:	435-716-2200
Fax Number	:

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

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	12/01/2025

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