Provider Demographics
NPI:1659579795
Name:BORISIAK, TATYANA STRUMKOVSKAYA (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:STRUMKOVSKAYA
Last Name:BORISIAK
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 1:8251 W BROWARD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:954-255-7310
Mailing Address - Fax:954-255-7311
Practice Address - Street 1:8251 W BROWARD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-255-7310
Practice Address - Fax:954-255-7311
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000559700Medicaid
FL71388OtherBCBS
FL71388OtherBCBS