Provider Demographics
NPI:1326086935
Name:BOROZAN, PHILIP G (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:BOROZAN
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 1:601 JOHN ST
Mailing Address - Street 2:M283A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-7696
Mailing Address - Fax:269-488-8313
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE 283A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-7696
Practice Address - Fax:269-488-8313
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010536032086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3218977-10Medicaid
109661OtherGREAT LAKES HLTH PLN
MI020C91020OtherBCBS GRP PIN
MI1326086935Medicaid
MI3403902640OtherBCBS IND PIN
5958100OtherAETNA PIN
MI3218977-10Medicaid
383148262OtherEIN-HEALTHCARE MI
MI0C97625024Medicare ID - Type Unspecified
MIC97618242Medicare PIN
MI020029724Medicare PIN
MI020C91020OtherBCBS GRP PIN