MEDICARE: KEVIN GEORGE BURKITT AUD

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	231H00000X	Audiologist	1601000339	MI
2	231H00000X	Audiologist	A.02301	OH

General Provider Information

NPI Number	:	1285630046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GEORGE BURKITT AUD

Provider Business Mailing Address
First Line	:	1701 MENTOR AVE STE 5
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-1459
Country	:	US
Telephone Number	:	440-357-4327
Fax Number	:	440-357-4328

Provider Business Practice Location Address
First Line	:	1701 MENTOR AVE STE 5
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-1459
Country	:	US
Telephone Number	:	440-357-4327
Fax Number	:	440-357-4328

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/10/2022

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