Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301070777 | MI |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301070777 | MI |
NPI | 1083615488 |
---|---|
Provider Name | Dr. Brian A Borden |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197-8634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3375351 | (05) | MI |
G28631 | (02) |