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General NPI Number Information
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NPI Number | 1023334828
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Entity Type | Individual
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Provider Name | SHIVAKANTH BURUGU M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 224 N LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2841
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Country | US
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Telephone | 337-560-1144
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Fax | 337-560-1102
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Provider Business Mailing Address
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Address Line | 300 W SAINT MARY BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70506-4638
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Country | US
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Telephone | 337-233-6593
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Fax | 337-235-1032
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD37848
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 321121
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License Number State | LA
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