MEDICARE: DR. PAMELA L BURGESS 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
1	208600000X	Surgery Physician	60690	MN
2	208C00000X	Colon & Rectal Surgery Physician	60690	MN
3	208600000X	Surgery Physician	064904	GA

General Provider Information

NPI Number	:	1558593061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA L BURGESS M.D.

Provider Business Mailing Address
First Line	:	4200 DAHLBERG DR STE 300
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4841
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:	952-512-5651

Provider Business Practice Location Address
First Line	:	2800 CHICAGO AVE STE 300
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1353
Country	:	US
Telephone Number	:	651-225-7855
Fax Number	:

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	07/12/2023

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