MEDICARE: DAWN M BURGESS RNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	28159755A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4116028	OTHER	IN	AETNA
2	188985	OTHER	KY	HEALTHLINK PPO
3	221001	OTHER	IN	WELBORN HEALTHCARE
4	91107974	OTHER	IL	ILLINOIS BLUE CROSS BLUE SHIELD
5	000000085654	OTHER	KY	KENTUCKY BLUE CROSS BLUE SHIELD
6	000000085654	OTHER	IN	INDIANA BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013164425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M BURGESS RNFA

Provider Business Mailing Address
First Line	:	2701 LINCOLN AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-1627
Country	:	US
Telephone Number	:	812-476-4400
Fax Number	:	812-476-0300

Provider Business Practice Location Address
First Line	:	2701 LINCOLN AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-1627
Country	:	US
Telephone Number	:	812-476-4400
Fax Number	:	812-476-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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Directions to “ DAWN M BURGESS RNFA” Practice Location

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