Provider Demographics
NPI:1285651042
Name:BORKERT, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BORKERT
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 1:1809 WADE HAMPTON BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4050
Mailing Address - Country:US
Mailing Address - Phone:864-322-4665
Mailing Address - Fax:864-232-4716
Practice Address - Street 1:1809 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4050
Practice Address - Country:US
Practice Address - Phone:864-322-4665
Practice Address - Fax:864-232-4716
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC286586Medicaid
SC286586Medicaid
SC8533Medicare PIN