Provider Demographics
NPI:1477663961
Name:BORDERS, MICHEL KIM (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:KIM
Last Name:BORDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 COPPERFIELD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2054
Mailing Address - Country:US
Mailing Address - Phone:815-726-1115
Mailing Address - Fax:815-726-3005
Practice Address - Street 1:1301 COPPERFIELD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60482-2054
Practice Address - Country:US
Practice Address - Phone:815-726-1115
Practice Address - Fax:815-726-3005
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09900608Medicaid
IL09900608Medicaid
E34326Medicare UPIN