Provider Demographics
NPI:1427511773
Name:BORECKY, DANIELA MARITZA (MD)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:MARITZA
Last Name:BORECKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:MARITZA
Other - Last Name:ALE-SALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2807 LAKE MICHIGAN DR NW # 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5831
Mailing Address - Country:US
Mailing Address - Phone:404-922-8177
Mailing Address - Fax:909-265-9463
Practice Address - Street 1:15100 WHITTAKER WAY
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8696
Practice Address - Country:US
Practice Address - Phone:616-935-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA178275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine