Provider Demographics
NPI:1578576328
Name:BOROOKHIM, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BOROOKHIM
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:PO BOX 17202
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-3202
Mailing Address - Country:US
Mailing Address - Phone:310-288-0881
Mailing Address - Fax:310-288-0896
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-288-0881
Practice Address - Fax:310-288-0896
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687060Medicaid
CAWA68706BMedicare ID - Type UnspecifiedINDIVITUAL ID #
CAW16779Medicare ID - Type UnspecifiedGROUP ID #
CA00A687060Medicaid