Provider Demographics
NPI:1841251378
Name:BORDEN, BRITT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRITT
Middle Name:MICHAEL
Last Name:BORDEN
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-0308
Mailing Address - Country:US
Mailing Address - Phone:312-502-4255
Mailing Address - Fax:
Practice Address - Street 1:180 N STETSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-6710
Practice Address - Country:US
Practice Address - Phone:312-502-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-02
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115105207RG0300X, 208D00000X, 207QA0401X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115105Medicaid
ILF300103781Medicare PIN
IL036115105Medicaid