Provider Demographics
NPI:1508007550
Name:BORDEN, MICHEAL J (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:J
Last Name:BORDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHEAL
Other - Middle Name:JUSTIN
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:12221 MERIT DR STE 1610
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2204
Mailing Address - Country:US
Mailing Address - Phone:214-217-1911
Mailing Address - Fax:214-217-1912
Practice Address - Street 1:12221 MERIT DR STE 1610
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2204
Practice Address - Country:US
Practice Address - Phone:214-217-1911
Practice Address - Fax:214-217-1912
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06084363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00975222OtherRAILROAD
TX281057402Medicaid
TXTXB127630Medicare PIN
TX281057403Medicare PIN
TXP00975222OtherRAILROAD
TXTXB127633Medicare PIN