Healthcare Provider Details

I. General information

NPI: 1063482214
Provider Name (Legal Business Name): ANDREA S BURCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 GREENE WAY STE C
LOUISVILLE KY
40220-4097
US

IV. Provider business mailing address

2307 GREENE WAY STE C
LOUISVILLE KY
40220-4097
US

V. Phone/Fax

Practice location:
  • Phone: 502-806-3376
  • Fax: 502-213-3999
Mailing address:
  • Phone: 502-806-3376
  • Fax: 502-213-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number44924
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number40176
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: