Basic Information
| Provider Information | |||||||||
| NPI: | 1013963768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDERS-ROBINSON | ||||||||
| FirstName: | ANGALA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828 CHICAGO AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2828 CHICAGO AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 53541 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0570033 | 01 | MI | PHP MCA | OTHER | 383553974 | 01 | MI | COMMERCIAL INSURANCE | OTHER | 135780023 | 01 | MI | BCBS PROVIDER NUMBER | OTHER | 130023121 | 01 | MI | RAILROAD MEDICARE | OTHER | 4B84119 | 01 | MI | HPM | OTHER | 424892511 | 05 | MI | MEDICAID | 1357800235 | 01 | MI | BLUE CARE NETWORK | OTHER | 561246 | 01 | MI | SELECT CARE | OTHER | C5483 | 01 | MI | MCARE | OTHER | 0500011 | 01 | MI | PHYSICIANS HEALTH PLAN | OTHER | 38262737007 | 01 | MI | CHAMPUS | OTHER |