Provider Demographics
NPI:1912991753
Name:BORTS, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BORTS
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 1:9701 LANDMARK PARKWAY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1665
Mailing Address - Country:US
Mailing Address - Phone:314-849-8700
Mailing Address - Fax:314-849-8737
Practice Address - Street 1:9701 LANDMARK PARKWAY DR STE 207
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:314-920-0588
Practice Address - Fax:314-849-8737
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G81207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203507512Medicaid
MO203507504Medicaid
MO203507512Medicaid
MO001013352Medicare ID - Type Unspecified
MO203507504Medicaid