Provider Demographics
NPI:1881043685
Name:BORUTA, JANE MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MAUREEN
Last Name:BORUTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2050 N HAGGERTY RD
Mailing Address - Street 2:STE120
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3795
Mailing Address - Country:US
Mailing Address - Phone:734-981-1086
Mailing Address - Fax:734-981-2259
Practice Address - Street 1:2050 N HAGGERTY RD
Practice Address - Street 2:STE120
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-981-1086
Practice Address - Fax:734-981-2259
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine