Basic Information
| Provider Information | |||||||||
| NPI: | 1801865506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SBOROV | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MINNESOTA ONCOLOGY | ||||||||
| Address2: | 2550 UNIVERSITY AVE W | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025311 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 6545 FRANCE AVE S | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529282900 | ||||||||
| FaxNumber: | 9529282944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 23282 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0104002 | 01 | MN | PREFERREDONE | OTHER | 23298 | 01 | MN | AMERICA'S PPO | OTHER | 31681700 | 05 | WI | MEDICAID | 3600786 | 01 | MN | MEDICA | OTHER | HP14322 | 01 | MN | HEALTHPARTNERS | OTHER | 405387700 | 05 | MN | MEDICAID | 8T411SB | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 103020 | 01 | MN | UCARE MN | OTHER |