Healthcare Provider Details

I. General information

NPI: 1548220817
Provider Name (Legal Business Name): PATRICK THOMAS BURNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JAMES SIMPSON JR WAY STE 201
COVINGTON KY
41011-0801
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR SUITE 300
LAKESIDE PARK KY
41017-1686
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-4111
  • Fax: 859-655-4815
Mailing address:
  • Phone: 859-655-4111
  • Fax: 859-655-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24790
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: