1831174572 NPI number — PAUL JOHN BORGMEIER JR. M.D.

Table of content: PAUL JOHN BORGMEIER JR. M.D. (NPI 1831174572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831174572 NPI number — PAUL JOHN BORGMEIER JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORGMEIER
Provider First Name:
PAUL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORGMEIER
Provider Other First Name:
PAUL
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831174572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 N MERIDIAN STREET
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-962-4940
Provider Business Mailing Address Fax Number:
317-962-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N SENATE BLVD
Provider Second Line Business Practice Location Address:
STE 315
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-962-3500
Provider Business Practice Location Address Fax Number:
317-962-2735
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME44223 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: 01066243 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 044005100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00946648 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200958350 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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