Provider Demographics
NPI:1457337784
Name:BOROVOY, MARC A (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:BOROVOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26750 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1211
Mailing Address - Country:US
Mailing Address - Phone:248-348-5300
Mailing Address - Fax:248-348-5410
Practice Address - Street 1:26750 PROVIDENCE PKWY
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-348-5300
Practice Address - Fax:248-348-5410
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB001342213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101283OtherCARE CHOICES
MI1740555Medicaid
MI4053355OtherAETNA
MIT34159OtherHAP
MI480F372470OtherBLUE CROSS BLUE SHIELD
MIC5077OtherMCARE
MIC5077OtherMCARE
MI1740555Medicaid
MICE4176Medicare PIN