Provider Demographics
NPI:1962473041
Name:BOREN, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BOREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 W ORANGE GROVE RD
Mailing Address - Street 2:STE. 604
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1139
Mailing Address - Country:US
Mailing Address - Phone:520-219-6100
Mailing Address - Fax:520-219-6119
Practice Address - Street 1:2001 W ORANGE GROVE RD
Practice Address - Street 2:STE. 604
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1139
Practice Address - Country:US
Practice Address - Phone:520-219-6100
Practice Address - Fax:520-219-6119
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG44341Medicare UPIN
AZ81984Medicare ID - Type Unspecified