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NPI Code Detail

MEDICARE: DR. JUSTIN JAMES BURDICK M.D.

MEDICARE: DR. JUSTIN JAMES BURDICK M.D.
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
1208600000XSurgery Physician01072757AIN

General Provider Information

NPI Number : 1467621136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN JAMES BURDICK M.D.
Provider Business Mailing Address
First Line : PO BOX 775383
Second Line :
City : CHICAGO
State : IL
Zip : 60677-5383
Country : US
Telephone Number : 812-376-5315
Fax Number :
Provider Business Practice Location Address
First Line : 2325 18TH ST STE 220
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5389
Country : US
Telephone Number : 812-376-5640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2008
Last Update Date : 09/09/2024

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Directions to “ DR. JUSTIN JAMES BURDICK M.D.” Practice Location

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