Provider Demographics
NPI:1891887675
Name:ROBERT I BOORSTEIN DO PC
Entity Type:Organization
Organization Name:ROBERT I BOORSTEIN DO PC
Other - Org Name:ADVANCE SURGICAL ASSOCIAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOORSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-478-7733
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1878
Mailing Address - Country:US
Mailing Address - Phone:248-478-7733
Mailing Address - Fax:248-478-3533
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-478-7733
Practice Address - Fax:248-478-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB007073208600000X
MIMR011373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1767737Medicaid
E33137Medicare UPIN
MI0M02930Medicare PIN