Provider Demographics
NPI:1568242055
Name:BRITT MICHAEL BORDEN MD
Entity Type:Organization
Organization Name:BRITT MICHAEL BORDEN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-846-8888
Mailing Address - Street 1:101 FOUNDRY DR STE 1209
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3445
Mailing Address - Country:US
Mailing Address - Phone:798-846-8888
Mailing Address - Fax:
Practice Address - Street 1:101 FOUNDRY DR STE 1209
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3445
Practice Address - Country:US
Practice Address - Phone:765-412-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty