Healthcare Provider Details

I. General information

NPI: 1336836907
Provider Name (Legal Business Name): JOSEPH APOSTOL BURROUGHS DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

555 W KINZIE ST APT 2504
CHICAGO IL
60654-5855
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041458951
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: