Provider Demographics
NPI:1205924446
Name:BB BORKAR PSC
Entity type:Organization
Organization Name:BB BORKAR PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAGWANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BORKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-581-0660
Mailing Address - Street 1:801 BARRET AVE
Mailing Address - Street 2:#301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204
Mailing Address - Country:US
Mailing Address - Phone:502-581-0660
Mailing Address - Fax:502-581-0960
Practice Address - Street 1:801 BARRET AVE
Practice Address - Street 2:#301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204
Practice Address - Country:US
Practice Address - Phone:502-581-0660
Practice Address - Fax:502-581-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18706207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64187065Medicaid
KY1048997OtherPASSPORT
KYC69467Medicare UPIN
KY64187065Medicaid