Provider Demographics
NPI:1053453142
Name:BORST, ELLEN E (DO)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:BORST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:E
Other - Last Name:ROLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5183
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-2000
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS32174207Q00000X
KS05-32174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I70758Medicare UPIN