Provider Demographics
NPI:1780767681
Name:BOROVIK, HARRY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ROBERT
Last Name:BOROVIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12679 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5271
Mailing Address - Country:US
Mailing Address - Phone:231-499-6882
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DR STE 401
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4648
Practice Address - Country:US
Practice Address - Phone:217-258-2409
Practice Address - Fax:217-258-2323
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHB052140207Y00000X
IL036067098207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0280198OtherBCBS
MI1850468Medicaid
MI383381206OtherPRIORITY HEALTH TAX ID
MI0280198OtherBCBS