Provider Demographics
NPI:1194801423
Name:BURRER, PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BURRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1742
Mailing Address - Country:US
Mailing Address - Phone:317-751-4259
Mailing Address - Fax:317-647-4392
Practice Address - Street 1:131 N RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1742
Practice Address - Country:US
Practice Address - Phone:317-751-4259
Practice Address - Fax:317-647-4392
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63709207Q00000X
MDD0091274207Q00000X
MIEMC0000985207Q00000X
CAC173607207Q00000X
GA88637207Q00000X
COCDR.0001116207Q00000X
NV21058207Q00000X, 207Q00000X
AZ63855207Q00000X, 207Q00000X
AL42474207Q00000X, 207Q00000X
IL036145121207Q00000X, 207Q00000X
IN01091408A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA156012OtherTUFTS
MAJ19293OtherBLUECROSS BLUESHIELD
IL036145121OtherSTATE LICENSE
MA3194329Medicaid
G76889Medicare UPIN