Provider Demographics
NPI:1518059997
Name:BOORSTEIN, ROBERT I (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:BOORSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7082 HAWK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4581
Mailing Address - Country:US
Mailing Address - Phone:248-752-0230
Mailing Address - Fax:248-855-1701
Practice Address - Street 1:28237 ORCHARD LAKE RD
Practice Address - Street 2:STE 103
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3740
Practice Address - Country:US
Practice Address - Phone:248-752-0230
Practice Address - Fax:248-855-1700
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB007073208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020F31144OtherBLUE CROSS OF MI
MI176773701Medicaid
MI0M02930001Medicare PIN
MI020F31144OtherBLUE CROSS OF MI