MEDICARE: DR. LOUIS BORGENICHT 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
1	208000000X	Pediatrics Physician	1555603-1205	UT

General Provider Information

NPI Number	:	1588748859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS BORGENICHT M.D.

Provider Business Mailing Address
First Line	:	850 E 300 S STE 5
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84102-2394
Country	:	US
Telephone Number	:	801-531-8689
Fax Number	:	801-531-1277

Provider Business Practice Location Address
First Line	:	850 E 300 S STE 5
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84102-2394
Country	:	US
Telephone Number	:	801-531-8689
Fax Number	:	801-531-1277

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LOUIS BORGENICHT M.D.” Practice Location

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