Provider Demographics
NPI:1831363886
Name:BORKOWF AND BORKOVEC MD SC
Entity type:Organization
Organization Name:BORKOWF AND BORKOVEC MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORKOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-289-9668
Mailing Address - Street 1:2350 NORTH LAKE DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4507
Mailing Address - Country:US
Mailing Address - Phone:414-289-9669
Mailing Address - Fax:414-289-9693
Practice Address - Street 1:2350 NORTH LAKE DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4507
Practice Address - Country:US
Practice Address - Phone:414-289-9669
Practice Address - Fax:414-289-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27123207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI398682808Medicaid
WIB51658Medicare UPIN