Provider Demographics
NPI:1831174572
Name:BORGMEIER, PAUL JOHN JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:BORGMEIER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:JOHN
Other - Last Name:BORGMEIER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:950 N MERIDIAN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3908
Mailing Address - Country:US
Mailing Address - Phone:317-962-4940
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:STE 315
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1252
Practice Address - Country:US
Practice Address - Phone:317-962-3500
Practice Address - Fax:317-962-2735
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44223207RR0500X
IN01066243207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044005100Medicaid
INP00946648OtherRAILROAD MEDICARE PTAN
IN200958350Medicaid
FL044005100Medicaid
IN675920ZMedicare PIN
FL39117Medicare PIN
FLD54246Medicare UPIN