Provider Demographics
NPI:1063591675
Name:BORIS KAIM, MD PA
Entity type:Organization
Organization Name:BORIS KAIM, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-544-6400
Mailing Address - Street 1:2311 N MESA ST STE F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3575
Mailing Address - Country:US
Mailing Address - Phone:915-444-6400
Mailing Address - Fax:915-544-2836
Practice Address - Street 1:2311 N MESA ST STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3575
Practice Address - Country:US
Practice Address - Phone:915-544-6400
Practice Address - Fax:915-544-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084S0012X
TXTEMPORARY363A00000X
TXE64482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326054164OtherDR. INDIVIDUAL NPI NUMBER
TX085590001Medicaid
TX136626206Medicaid
TX81Z601OtherBC/BS TX PROVIDER NUMBER
TX00U22MMedicare ID - Type Unspecified
TX136626206Medicaid