Healthcare Provider Details

I. General information

NPI: 1427043181
Provider Name (Legal Business Name): ANDREW E BURG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER HERITAGE BLVD SUITE 204
BRADENTON FL
34212-6348
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-7100
  • Fax: 941-917-7142
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME91867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: