Provider Demographics
NPI:1336191139
Name:BORENITSCH, ROBERT LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:BORENITSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROBERT L. BORENITSCH D.O.
Mailing Address - Street 2:6311 CANNON HIGHLANDS DR N.E
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306
Mailing Address - Country:US
Mailing Address - Phone:989-793-6138
Mailing Address - Fax:989-793-5638
Practice Address - Street 1:5200 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3713
Practice Address - Country:US
Practice Address - Phone:989-793-6138
Practice Address - Fax:989-793-5638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB006842207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1634267Medicaid
F00488Medicare UPIN
57300105172Medicare ID - Type Unspecified