Provider Demographics
NPI:1073669024
Name:HARRY R BOROVIK MD PC
Entity Type:Organization
Organization Name:HARRY R BOROVIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOROVIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-3223
Mailing Address - Street 1:1221 6TH STREET
Mailing Address - Street 2:SUITE 102 MUNSON PROFESSIONAL BLDG
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-935-3223
Mailing Address - Fax:231-935-3221
Practice Address - Street 1:1221 6TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-3223
Practice Address - Fax:231-935-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HB052140207Y00000X
MI0B80310332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1850468Medicaid
0B80310OtherBCBS HEARING AID
MI1850468Medicaid
MI0280198Medicare PIN
0B80310OtherBCBS HEARING AID