Provider Demographics
NPI:1649233537
Name:BORSON, ROBERT ELLIOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:BORSON
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 1:4536 STONEVIEW
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3498
Mailing Address - Country:US
Mailing Address - Phone:248-399-1936
Mailing Address - Fax:248-399-9286
Practice Address - Street 1:2349 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1550
Practice Address - Country:US
Practice Address - Phone:248-399-1936
Practice Address - Fax:248-399-9286
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000957213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2107964Medicaid
MI2107964Medicaid
MIT34119Medicare UPIN