Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036115105 | IL |
N | 207RG0300X | Geriatric Medicine | 036115105 | IL |
N | 207T00000X | Neurosurgeon | 036115105 | IL |
N | 208D00000X | General Practice Physician | 036115105 | IL |
NPI | 1841251378 |
---|---|
Provider Name | Dr. Britt Michael Borden |
First Address | Flossmoor, IL 60422-0308 |
Second Address | Chicago, IL 60601-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2006 |
Last Update Date | 07/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036115105 | (05) | IL |
H60609 | (02) |