Provider Demographics
NPI:1588663090
Name:BORRELLI, GEORGE W (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:BORRELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9944 S ROBERTS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1555
Mailing Address - Country:US
Mailing Address - Phone:708-233-8709
Mailing Address - Fax:
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1256
Practice Address - Country:US
Practice Address - Phone:708-923-5800
Practice Address - Fax:708-923-8324
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18550Medicare UPIN
L50984Medicare PIN
IL762690Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER