Healthcare Provider Details

I. General information

NPI: 1336406834
Provider Name (Legal Business Name): KATRINA ELIZABETH BURNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE M/C 3077
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

180 HARVESTER DR SUITE 110
BURR RIDGE IL
60527-7594
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1220
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036136453
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number336102496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: