Healthcare Provider Details

I. General information

NPI: 1215936190
Provider Name (Legal Business Name): TODD S BURRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MARY ST STE 520
EVANSVILLE IN
47710-1682
US

IV. Provider business mailing address

520 MARY ST SUITE 520
EVANSVILLE IN
47710-1682
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-8231
  • Fax: 812-435-8794
Mailing address:
  • Phone: 812-424-8231
  • Fax: 812-435-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01055481A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40328
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: