MEDICARE: KEVIN L. BORST DO

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	34009832	OH

General Provider Information

NPI Number	:	1982818506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN L. BORST DO

Provider Business Mailing Address
First Line	:	4810 TILLMAN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2266
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14601 DETROIT AVE STE 540
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4251
Country	:	US
Telephone Number	:	216-529-5300
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	06/28/2011

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