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General NPI Number Information
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NPI Number | 1205028164
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Entity Type | Individual
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Provider Name | LAURA MATHIS BURDICK MD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 360 PLAZA DR SUITE C
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City | COLUMBUS
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State | IN
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Zip | 47201-2960
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Country | US
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Telephone | 812-376-9868
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Fax | 812-376-9697
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Provider Business Mailing Address
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Address Line | 360 PLAZA DR SUITE C
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City | COLUMBUS
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State | IN
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Zip | 47201-2960
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Country | US
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Telephone | 812-376-9686
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Fax | 812-376-9697
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 01072756A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01072756A
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License Number State | IN
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