Provider Demographics
NPI:1407941255
Name:BORTNICK, CARY J (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:J
Last Name:BORTNICK
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 1:4800 LINTON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-498-5660
Mailing Address - Fax:561-498-0753
Practice Address - Street 1:4800 LINTON BLVD STE F107
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6506
Practice Address - Country:US
Practice Address - Phone:561-498-5660
Practice Address - Fax:561-498-0753
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066875207R00000X
FLME138841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02201555OtherBCBS
IL036066875Medicaid
IL110015661AMedicare PIN
ILL02939Medicare ID - Type Unspecified
IL036066875Medicaid