Individual
MICHAEL D BORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
(734) 246-8895
(734) 324-3404
Mailing address
1640 FORT STREET, SUITE D ATTN DENISE, TRENTON, MI 48183
(734) 391-3057
(734) 391-3052
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
5101010520
MI
207VM0101X
Maternal & Fetal Medicine Physician
Primary
5101010520
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24657
BLUE CROSS
MI
01
—
382791823
TAX ID
MI
01
—
F67493
UPIN
MI
Enumeration date
02/01/2006
Last updated
02/21/2017
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