Provider Demographics
NPI:1396728135
Name:BORSHEIM, MARK P (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:BORSHEIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1551 E MULLAN AVE STE 200B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9005
Practice Address - Country:US
Practice Address - Phone:208-262-2313
Practice Address - Fax:208-262-2314
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2025-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM-6013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1396728135Medicaid
ID1126472Medicare ID - Type Unspecified
ID002705800Medicaid
ID4986080001Medicare NSC