Provider Demographics
NPI:1770574857
Name:BORODKIN, STEPHEN LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:BORODKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4776 E GUADALUPE RD
Mailing Address - Street 2:APT #3084
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7501
Mailing Address - Country:US
Mailing Address - Phone:602-955-5553
Mailing Address - Fax:
Practice Address - Street 1:1255 EAST BROADWAY ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-929-5100
Practice Address - Fax:480-731-1066
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ255162084P0800X
NV113572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39405Medicare UPIN