Provider Demographics
NPI:1083605893
Name:BORCH-CHRISTENSEN, OLE (MD)
Entity Type:Individual
Prefix:
First Name:OLE
Middle Name:
Last Name:BORCH-CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-978-1500
Mailing Address - Fax:602-978-0409
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:STE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-978-1500
Practice Address - Fax:602-978-0409
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9005207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ222620Medicaid
WCKHB02Medicare ID - Type Unspecified
E31348Medicare UPIN