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General NPI Number Information
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NPI Number | 1386064376
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Entity Type | Organization
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Legal Business Name | P.O.BURGAN M.D. INC.
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 303 N FOREST DR
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City | KOKOMO
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State | IN
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Zip | 46901-4254
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Country | US
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Telephone | 765-438-6611
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Fax | 765-456-3414
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Provider Business Mailing Address
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Address Line | 303 N FOREST DR
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City | KOKOMO
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State | IN
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Zip | 46901-4254
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Country | US
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Telephone | 765-438-6611
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Fax | 765-456-3414
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHIL OWEN BURGAN
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Credential | M.D.
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Telephone | 765-438-1647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 01023827A
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License Number State | IN
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