Provider Demographics
NPI:1275827511
Name:BORDNER, MICHAEL PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:BORDNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DARDANELLI LN
Mailing Address - Street 2:SUITE 1-G
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2900
Mailing Address - Fax:
Practice Address - Street 1:360 DARDANELLI LN
Practice Address - Street 2:SUITE 1-G
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20379363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical