Healthcare Provider Details

I. General information

NPI: 1528266285
Provider Name (Legal Business Name): BRYAN T BURNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5637 W 700 N
MC CORDSVILLE IN
46055-9567
US

IV. Provider business mailing address

5637 W 700 N
MC CORDSVILLE IN
46055-9567
US

V. Phone/Fax

Practice location:
  • Phone: 317-335-2999
  • Fax: 317-336-7674
Mailing address:
  • Phone: 317-335-2999
  • Fax: 317-336-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01025624A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: