MEDICARE: ANDREA BORN

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	F02190332	OH

General Provider Information

NPI Number	:	1689232308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BORN

Provider Business Mailing Address
First Line	:	10835 RAMM RD
Second Line	:
City	:	WHITEHOUSE
State	:	OH
Zip	:	43571-9384
Country	:	US
Telephone Number	:	567-277-6917
Fax Number	:

Provider Business Practice Location Address
First Line	:	6135 TRUST DR STE 230
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9360
Country	:	US
Telephone Number	:	567-703-8696
Fax Number	:

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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Directions to “ ANDREA BORN ” Practice Location

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