MEDICARE: MB INTEGRATIVE MEDICINE LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1962872861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MB INTEGRATIVE MEDICINE LLC

Provider Business Mailing Address
First Line	:	6803 EMLEN ST
Second Line	:	APT 209
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2635
Country	:	US
Telephone Number	:	267-506-0642
Fax Number	:	267-502-3000

Provider Business Practice Location Address
First Line	:	6782 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2110
Country	:	US
Telephone Number	:	267-506-0642
Fax Number	:	267-502-3000

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. MELISSA BORRERO
Credential	:	MD
Telephone Number	:	267-506-0642

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	10/05/2015

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