Provider Demographics
NPI:1386653913
Name:BORN, ERIC EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
Last Name:BORN
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 1:2350 E G AVE
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1943
Mailing Address - Country:US
Mailing Address - Phone:269-344-6183
Mailing Address - Fax:269-349-3046
Practice Address - Street 1:2350 E G AVE
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1943
Practice Address - Country:US
Practice Address - Phone:269-344-6183
Practice Address - Fax:269-349-3046
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114621039Medicaid
E92642Medicare UPIN
MI114621039Medicaid