Provider Demographics
NPI:1770032427
Name:BORLOT, FELIPPE (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:FELIPPE
Middle Name:
Last Name:BORLOT
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2745
Mailing Address - Country:US
Mailing Address - Phone:801-585-2868
Mailing Address - Fax:801-581-4192
Practice Address - Street 1:175 N MEDICAL DR E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-2868
Practice Address - Fax:801-581-4192
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCREMESP 1176642084N0402X
ZZCPSO# 101447390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program