Provider Demographics
NPI:1770536567
Name:BORGNES, ERIK MATHEW (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:MATHEW
Last Name:BORGNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 134TH ST SW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5322
Mailing Address - Country:US
Mailing Address - Phone:425-297-6200
Mailing Address - Fax:
Practice Address - Street 1:728 134TH ST SW
Practice Address - Street 2:SUITE 120
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5322
Practice Address - Country:US
Practice Address - Phone:425-297-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI346012085R0202X
WAMD000348222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32512300Medicaid
WI00517115Medicare ID - Type Unspecified
WI32512300Medicaid