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General NPI Number Information
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NPI Number | 1013058379
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Entity Type | Individual
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Provider Name | MIGUEL BURGOS M.D
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/30/2011
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Provider Practice Location Address
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Address Line | 229 W GRAND AVENUE SUITE QW
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City | BENSENVILLE
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State | IL
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Zip | 60106
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Country | US
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Telephone | 630-422-1917
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Fax | 630-422-7226
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Provider Business Mailing Address
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Address Line | 229 W GRAND AVENUE SUITE QW
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City | BENSENVILLE
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State | IL
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Zip | 60106
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Country | US
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Telephone | 630-422-1917
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Fax | 630-422-7226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036103673
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License Number State | IL
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