Provider Demographics
NPI:1063447605
Name:BORROMEO, MICHAEL ANTHONY P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL ANTHONY
Middle Name:P
Last Name:BORROMEO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:24760 HOSPITAL DRIVE
Mailing Address - Street 2:BOX 497
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0165
Mailing Address - Country:US
Mailing Address - Phone:218-679-3912
Mailing Address - Fax:218-679-0181
Practice Address - Street 1:HIGHWAY 1
Practice Address - Street 2:IHS BOX 165
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0165
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:218-679-0181
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-11-07
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Provider Licenses
StateLicense IDTaxonomies
MN43108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34G20BOOtherBC/BS OF MN
MNHSZ009OtherPART B
MNHSZ011OtherPART B
MN510010100Medicaid
MN34G20BOOtherBC/BS OF MN
MNHSZ011OtherPART B
MN510010100Medicaid
MN240206Medicare Oscar/Certification