Lisa A Boros-Laurain, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601004322 Issued in MI

Practice address

3133 S.Telegraph
Dearborn, MI 48124

Phone

(313) 565-6566

Fax

(313) 561-5554

NPI assigned

Jul 15, 2008

Last updated

Jul 15, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1669636130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3133 S.TELEGRAPH",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124",
            "telephone_number": "313-565-6566",
            "fax_number": "313-561-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3133 S.TELEGRAPH",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124",
            "telephone_number": "313-565-6566",
            "fax_number": "313-561-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOROS-LAURAIN",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-15",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN'S   ASSISTANT LICENSE",
            "identifier": "5601004322",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Audrianna Bornamann, PT, DPT
• Kimberly A Borrego, CRNA
• Ricardo D Borrego, M.D.
• Mary Botu
• Madeleine Boudreau, LLMSW
• Alex Bouhachem, DPM

• Medical Physician Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.