Healthcare Provider Details

I. General information

NPI: 1700866449
Provider Name (Legal Business Name): JOSEPH P BURICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S CLEVELAND AVE SUITE 300
MOGADORE OH
44260-2200
US

IV. Provider business mailing address

754 S CLEVELAND AVE SUITE 300
MOGADORE OH
44260-2200
US

V. Phone/Fax

Practice location:
  • Phone: 330-628-2686
  • Fax: 330-628-0828
Mailing address:
  • Phone: 330-628-2686
  • Fax: 330-628-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-2729
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: