Provider Demographics
NPI:1255651725
Name:BORCHARDT, MAE KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:KATHLEEN
Last Name:BORCHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-797-9666
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 901
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2720
Practice Address - Country:US
Practice Address - Phone:713-797-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10037816207V00000X
TXP8860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01510315OtherRR MEDICARE
TX338261602Medicaid
TX338261601Medicaid
TX8EH198OtherBLUE CROSS BLUE SHIELD
TX8EH198OtherBLUE CROSS BLUE SHIELD