Provider Demographics
NPI:1245270404
Name:BORSA, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BORSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 504807
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4807
Mailing Address - Country:US
Mailing Address - Phone:913-234-1496
Mailing Address - Fax:913-234-1116
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:STE 1400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-930-6035
Practice Address - Fax:913-234-1116
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20020122902085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205829005Medicaid
KS100422770AMedicaid
MO30790014OtherBCBS
MO300130623OtherRAILROAD MEDICARE
MO300130623OtherRAILROAD MEDICARE
F49134Medicare UPIN