Provider Demographics
NPI:1538384284
Name:BORGARDT, WILLIAM HENRY (MACOM)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:BORGARDT
Suffix:
Gender:M
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028B OLD HIGHWAY 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-8765
Mailing Address - Country:US
Mailing Address - Phone:509-685-0341
Mailing Address - Fax:
Practice Address - Street 1:1028B OLD HIGHWAY 12 MILE RD
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-8765
Practice Address - Country:US
Practice Address - Phone:509-685-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist