MEDICARE: DR. MARTIN BURGER DO

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	207W00000X	Ophthalmology Physician	OS8473	FL

General Provider Information

NPI Number	:	1790240711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN BURGER DO

Provider Business Mailing Address
First Line	:	2 GRAPE VINE LN
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-8529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12094 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1729
Country	:	US
Telephone Number	:	352-752-0075
Fax Number	:

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

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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