Healthcare Provider Details

I. General information

NPI: 1174509129
Provider Name (Legal Business Name): TED H BURNINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 RYANS RD
WORTHINGTON MN
56187-1722
US

IV. Provider business mailing address

1216 RYANS RD
WORTHINGTON MN
56187-1722
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-2921
  • Fax: 507-372-6435
Mailing address:
  • Phone: 507-372-2921
  • Fax: 507-372-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2758781205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: