Provider Demographics
NPI:1225205115
Name:BORG, STANLEY (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:BORG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N COLUMBUS DR
Mailing Address - Street 2:#4703
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7810
Mailing Address - Country:US
Mailing Address - Phone:312-856-0038
Mailing Address - Fax:
Practice Address - Street 1:222 N COLUMBUS DR
Practice Address - Street 2:#4703
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7810
Practice Address - Country:US
Practice Address - Phone:312-856-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine