MEDICARE: KEVIN BURROUGHS MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	9901134	NC
2	207Q00000X	Family Medicine Physician	9901134	NC

General Provider Information

NPI Number	:	1750378576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BURROUGHS MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 COPPERFIELD BLVD NE
Second Line	:	STE 102
City	:	CONCORD
State	:	NC
Zip	:	28025-2441
Country	:	US
Telephone Number	:	704-786-6521
Fax Number	:

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/15/2024

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