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NPI Code Detail

MEDICARE: KRAIG M BURGESS D.O.

MEDICARE: KRAIG M BURGESS D.O.
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
1207X00000XOrthopaedic Surgery Physician4169AZ
2207XS0106XOrthopaedic Hand Surgery Physician4169AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396735882
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRAIG M BURGESS D.O.
Provider Business Mailing Address
First Line : PO BOX 80217
Second Line :
City : PHOENIX
State : AZ
Zip : 85060-0217
Country : US
Telephone Number : 602-385-2115
Fax Number : 480-418-3323
Provider Business Practice Location Address
First Line : 18555 N 79TH AVE STE E101
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-8392
Country : US
Telephone Number : 602-648-5444
Fax Number : 602-772-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 07/25/2022

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Directions to “ KRAIG M BURGESS D.O.” Practice Location

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