Provider Demographics
NPI:1609858448
Name:BORCHARD, CHARLES A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:BORCHARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 W GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3951
Mailing Address - Country:US
Mailing Address - Phone:989-792-7878
Mailing Address - Fax:989-792-7773
Practice Address - Street 1:2604 W GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3951
Practice Address - Country:US
Practice Address - Phone:989-792-7878
Practice Address - Fax:989-792-7773
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001384213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4857350010OtherBCBS AND HPM
MI1883119Medicaid
MIP105762OtherBCN
MI480006381OtherMRRR
MIP105762OtherBCN
MI480006381OtherMRRR