MEDICARE: DR. STEPHEN JAMES BURGUN 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	33851	AZ
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35-071102	OH

General Provider Information

NPI Number	:	1396831798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JAMES BURGUN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-285-3621
Fax Number	:	440-285-3625

Provider Business Practice Location Address
First Line	:	13221 RAVENNA RD STE 1
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-9016
Country	:	US
Telephone Number	:	440-285-3621
Fax Number	:	440-285-3625

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/30/2020

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