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NPI Code Detail

MEDICARE: MRS. SUE E BURROWS

MEDICARE: MRS. SUE E BURROWS
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
1174400000XSpecialist056.001340IL

General Provider Information

NPI Number : 1962668921
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUE E BURROWS
Provider Business Mailing Address
First Line : 16601 SERENE LAKE WAY
Second Line :
City : CRESTHILL
State : IL
Zip : 60403-0808
Country : US
Telephone Number : 815-582-4405
Fax Number :
Provider Business Practice Location Address
First Line : 12550 S RIDGELAND AVE
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1859
Country : US
Telephone Number : 708-597-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2008
Last Update Date : 07/30/2008

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Directions to “ MRS. SUE E BURROWS ” Practice Location

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