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1679508071

NPI Code Detail

MEDICARE: PATRICE BURCH MD

MEDICARE: PATRICE BURCH MD

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	207P00000X	Emergency Medicine Physician	036-115-400	IL
2	207Q00000X	Family Medicine Physician	036-115400	IL

General Provider Information

NPI Number	:	1679508071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE BURCH MD

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	9831 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1740
Country	:	US
Telephone Number	:	773-445-3500
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/29/2022

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Directions to “ PATRICE BURCH MD” Practice Location

Language	Start Address	Practice Location

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