Provider Demographics
NPI:1548285299
Name:BORRERO, FLOR L (MD)
Entity type:Individual
Prefix:MRS
First Name:FLOR
Middle Name:L
Last Name:BORRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3637 CLYDE PARK AVE SW
Mailing Address - Street 2:STE. 4
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4095
Mailing Address - Country:US
Mailing Address - Phone:616-808-3265
Mailing Address - Fax:616-726-7019
Practice Address - Street 1:3637 CLYDE PARK AVE SW
Practice Address - Street 2:STE. 4
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4095
Practice Address - Country:US
Practice Address - Phone:616-808-3265
Practice Address - Fax:616-726-7019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID48289Medicare UPIN