Provider Demographics
NPI:1447214127
Name:BORENSTEIN, MICHAEL TED (MD PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TED
Last Name:BORENSTEIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 RCA CENTER DR
Mailing Address - Street 2:SUITE 3015
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4276
Mailing Address - Country:US
Mailing Address - Phone:561-776-7041
Mailing Address - Fax:561-776-7043
Practice Address - Street 1:11030 RCA CENTER DR
Practice Address - Street 2:SUITE 3015
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4276
Practice Address - Country:US
Practice Address - Phone:561-776-7041
Practice Address - Fax:561-776-7043
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89837207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09572Medicare UPIN