Provider Demographics
NPI:1801865506
Name:SBOROV, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SBOROV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MINNESOTA ONCOLOGY
Mailing Address - Street 2:2550 UNIVERSITY AVE W
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5311
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE #210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-02-01
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Provider Licenses
StateLicense IDTaxonomies
MN23282207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0104002OtherPREFERREDONE
MN23298OtherAMERICA'S PPO
WI31681700Medicaid
MN3600786OtherMEDICA
MNHP14322OtherHEALTHPARTNERS
MN405387700Medicaid
MN8T411SBOtherBLUE CROSS BLUE SHIELD MN
MN103020OtherUCARE MN
MNA95342Medicare UPIN
MN900000091Medicare ID - Type UnspecifiedMN MEDICARE
WI31681700Medicaid