Provider Demographics
NPI:1285682963
Name:BORGWARDT, BRAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:M
Last Name:BORGWARDT
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 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24094207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
018390OtherHEALTH ALLIANCE
18975OtherMIDLANDS CHOICE
IA0217380Medicaid
IL09822166OtherILLINOIS - BC/BS
27209OtherIOWA HEALTH SOLUTIONS
20306OtherWELLMARK BC/BS
E14405OtherJOHN DEERE HEALTH
20306OtherWELLMARK BC/BS
IL09822166OtherILLINOIS - BC/BS
18975OtherMIDLANDS CHOICE
IA0217380Medicaid
ILL07550Medicare PIN