Provider Demographics
NPI:1659459576
Name:TILLER-BORCICH, JANICE K (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:TILLER-BORCICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2020
Mailing Address - Country:US
Mailing Address - Phone:808-974-6898
Mailing Address - Fax:808-935-6928
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2020
Practice Address - Country:US
Practice Address - Phone:808-974-6898
Practice Address - Fax:808-935-6928
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13591207ZN0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI258533OtherHMSA
HI581993Medicaid
HI58199300OtherALOHACARE
HI581993Medicaid