Provider Demographics
NPI:1366971442
Name:BORCHERDING, SAMUEL C (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:BORCHERDING
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:FAMILY MEDICAL CENTER
Mailing Address - Street 2:225 S PINE STREET, SUITE 200
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-524-3333
Mailing Address - Fax:812-524-3334
Practice Address - Street 1:FAMILY MEDICAL CENTER
Practice Address - Street 2:225 S PINE STREET, SUITE 200
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274
Practice Address - Country:US
Practice Address - Phone:812-524-3333
Practice Address - Fax:812-524-3334
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080992A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine