Provider Demographics
NPI:1215611090
Name:BORTELY, BLANKA (MD)
Entity type:Individual
Prefix:
First Name:BLANKA
Middle Name:
Last Name:BORTELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 INKSTER ROAD
Mailing Address - Street 2:OFFICE ANU JOSE RESIDENCY PROGRAM COORDINATOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135
Mailing Address - Country:US
Mailing Address - Phone:734-458-4319
Mailing Address - Fax:734-458-4496
Practice Address - Street 1:6245 INKSTER ROAD
Practice Address - Street 2:OFFICE ANU JOSE RESIDENCY PROGRAM COORDINATOR
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:734-458-4319
Practice Address - Fax:734-458-4496
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program