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NPI Code Detail

MEDICARE: DR. HARRIET CHANA BURSZTYN M.D.

MEDICARE: DR. HARRIET CHANA BURSZTYN 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
12084P0800XPsychiatry PhysicianIL

General Provider Information

NPI Number : 1457485179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARRIET CHANA BURSZTYN M.D.
Provider Business Mailing Address
First Line : 2709 LAKEVIEW DR
Second Line :
City : CHAMPAIGN
State : IL
Zip : 61822-7534
Country : US
Telephone Number : 217-333-2705
Fax Number : 217-244-1758
Provider Business Practice Location Address
First Line : 1109 S LINCOLN AVE
Second Line :
City : URBANA
State : IL
Zip : 61801-4703
Country : US
Telephone Number : 217-333-2705
Fax Number : 217-244-1758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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