Provider Demographics
NPI:1326035767
Name:BORDENAVE, GEORGE HUMBERTO (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:HUMBERTO
Last Name:BORDENAVE
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 1:8720 N KENDALL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2208
Mailing Address - Country:US
Mailing Address - Phone:305-446-2444
Mailing Address - Fax:305-446-7847
Practice Address - Street 1:8720 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2299
Practice Address - Country:US
Practice Address - Phone:305-446-2444
Practice Address - Fax:305-446-7847
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055836207RC0000X
TNMD0000036724207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06465800Medicaid
FLBB2148167OtherDEA
FL11549Medicare ID - Type Unspecified
FL06465800Medicaid