Provider Demographics
NPI:1184509804
Name:BORTI, DANIEL KOMLA
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KOMLA
Last Name:BORTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 ROYAL POINT DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1354
Mailing Address - Country:US
Mailing Address - Phone:307-343-6831
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW STE 629
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4671
Practice Address - Country:US
Practice Address - Phone:616-512-3210
Practice Address - Fax:855-231-2592
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program