Provider Demographics
NPI:1346212800
Name:BORIN, ANDREW J (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:BORIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38525 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1012
Mailing Address - Country:US
Mailing Address - Phone:734-464-8800
Mailing Address - Fax:734-542-3115
Practice Address - Street 1:38525 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1012
Practice Address - Country:US
Practice Address - Phone:734-464-8800
Practice Address - Fax:734-542-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007540207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM08470OtherMEDICARE
MI113119600Medicaid
MI311960011Medicaid
MIOM08470Medicare ID - Type Unspecified
OM08470OtherMEDICARE
MI113119600Medicaid