MEDICARE: DR. WILLIAM C BORGERDING 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	5101009625	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0151600085	OTHER	MI	INDIVIDUAL BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669498424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C BORGERDING D.O.

Provider Business Mailing Address
First Line	:	PO BOX 419
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-0419
Country	:	US
Telephone Number	:	231-627-5601
Fax Number	:	231-627-1471

Provider Business Practice Location Address
First Line	:	740 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2220
Country	:	US
Telephone Number	:	231-627-1471
Fax Number	:	231-627-1364

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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