Provider Demographics
NPI:1265629893
Name:MICHAEL C. BORDOFSKY MD
Entity Type:Organization
Organization Name:MICHAEL C. BORDOFSKY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-963-3336
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3336
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:2320 BATH ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4344
Practice Address - Country:US
Practice Address - Phone:805-963-3336
Practice Address - Fax:805-564-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G753640208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G753640Medicaid
CA110138625OtherRAILROAD MEDICARE
CAW15667Medicare PIN