Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 43054536 | MI |
N | 207PE0004X | Emergency Medical Services | 4301054536 | MI |
Y | 207R00000X | Internist | 4301054536 | MI |
Y | 111NI0900X | Internist | 4301054536 | MI |
NPI | 1073614251 |
---|---|
Provider Name | Michael W Borgeld |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49525-7004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 03/05/2017 |