Provider Demographics
NPI:1023100393
Name:BORELLI, MICHAEL ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:BORELLI
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:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:CEDAR KEY
Mailing Address - State:FL
Mailing Address - Zip Code:32625
Mailing Address - Country:US
Mailing Address - Phone:352-543-5722
Mailing Address - Fax:
Practice Address - Street 1:2801 KENNEDY ST
Practice Address - Street 2:PUTNAM COUNTY HEALTH DEPARTMENT
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4109
Practice Address - Country:US
Practice Address - Phone:386-326-3200
Practice Address - Fax:386-326-3350
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069472000Medicaid
FL069472000Medicaid
D21572Medicare UPIN