Healthcare Provider Details

I. General information

NPI: 1962496661
Provider Name (Legal Business Name): SUSANNA R BURKHEAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVENUE
EVANSVILLE IN
47750-0001
US

IV. Provider business mailing address

P O BOX 359
EVANSVILLE IN
47703-0359
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4000
  • Fax:
Mailing address:
  • Phone: 812-485-1220
  • Fax: 812-485-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01066004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: