MEDICARE: SHIVAKANTH BURUGU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	MD37848	SC
2	207RN0300X	Nephrology Physician	321121	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023334828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVAKANTH BURUGU M.D.

Provider Business Mailing Address
First Line	:	300 W SAINT MARY BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4638
Country	:	US
Telephone Number	:	337-233-6593
Fax Number	:	337-235-1032

Provider Business Practice Location Address
First Line	:	224 N LEWIS ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2841
Country	:	US
Telephone Number	:	337-560-1144
Fax Number	:	337-560-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	05/30/2024

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