Provider Demographics
NPI:1528009644
Name:BOORSTEIN, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:BOORSTEIN
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 1:752 N HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2236
Mailing Address - Country:US
Mailing Address - Phone:608-824-4800
Mailing Address - Fax:608-824-4910
Practice Address - Street 1:752 N HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2236
Practice Address - Country:US
Practice Address - Phone:608-824-4800
Practice Address - Fax:608-824-4910
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI40438-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528009644Medicaid
WI6535OtherDEAN HEALTH INSURANCE
WI180034744Medicare PIN
WI6535OtherDEAN HEALTH INSURANCE
G27048Medicare UPIN
WI130800402Medicare PIN
WI055074150Medicare PIN
WI543401679Medicare PIN