Healthcare Provider Details

I. General information

NPI: 1053534958
Provider Name (Legal Business Name): LAURENCE I BURD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST 4TH FLOOR
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

820 S WOOD ST MC 808
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7500
  • Fax:
Mailing address:
  • Phone: 312-996-7300
  • Fax: 312-996-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number36-041073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: