Provider Demographics
NPI:1831064674
Name:BORGE, CHESTER (PA-C)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:BORGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 NW 107TH AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3873
Mailing Address - Country:US
Mailing Address - Phone:786-488-2549
Mailing Address - Fax:
Practice Address - Street 1:322 NW 107TH AVE APT 8A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3873
Practice Address - Country:US
Practice Address - Phone:786-488-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9120982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant