Provider Demographics
NPI:1407902158
Name:BORGERSON, GREGORY E (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:BORGERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4798 WENMAR DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2843
Mailing Address - Country:US
Mailing Address - Phone:989-790-5980
Mailing Address - Fax:989-790-7182
Practice Address - Street 1:4798 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2843
Practice Address - Country:US
Practice Address - Phone:989-790-5980
Practice Address - Fax:989-790-7182
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1183233OtherCIGNA BEHAVIORAL
MI680G345300OtherBLUE CROSS BLUE SHIELD
MIA908706OtherVALUE OPTIONS
MI630101OtherCHAMPUS
MI680G345300OtherBLUE CROSS BLUE SHIELD