Provider Demographics
NPI:1073505327
Name:BORDOFSKY, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BORDOFSKY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:515 E MICHELTORENA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2257
Mailing Address - Country:US
Mailing Address - Phone:805-563-3234
Mailing Address - Fax:805-563-3130
Practice Address - Street 1:515 E MICHELTORENA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2257
Practice Address - Country:US
Practice Address - Phone:805-563-3234
Practice Address - Fax:805-563-3130
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2020-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG75364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110138625OtherRAILROAD MEDICARE
CA00G753640Medicaid
F63126Medicare UPIN