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General NPI Number Information
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NPI Number | 1063492478
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Entity Type | Individual
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Provider Name | KELLY L. BURGHARD M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 7335 YANKEE RD STE 201
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-1253
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Country | US
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Telephone | 513-564-6818
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Fax | 513-564-6819
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Provider Business Mailing Address
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Address Line | 7335 YANKEE RD STE 201
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-1253
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Country | US
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Telephone | 513-564-6818
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Fax | 513-564-6819
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.082204
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License Number State | OH
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