MEDICARE: DR. MIGUEL TOMAS NUNEZ BURGOS 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	207R00000X	Internal Medicine Physician	25MA09454600	NJ
2	207R00000X	Internal Medicine Physician	MD61261486	WA

General Provider Information

NPI Number	:	1811328396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL TOMAS NUNEZ BURGOS MD

Provider Business Mailing Address
First Line	:	13206 BOTHELL EVERETT HWY STE 401A
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-3402
Country	:	US
Telephone Number	:	833-411-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	13206 BOTHELL EVERETT HWY STE 401A
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-3402
Country	:	US
Telephone Number	:	833-411-5469
Fax Number	:

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	06/23/2023

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