Provider Demographics
NPI:1336213032
Name:BURT, TRIPTI (MD SC)
Entity type:Individual
Prefix:DR
First Name:TRIPTI
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 EDWARDS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1692
Mailing Address - Country:US
Mailing Address - Phone:815-318-5010
Mailing Address - Fax:815-941-6431
Practice Address - Street 1:1345 EDWARDS ST STE 1
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1692
Practice Address - Country:US
Practice Address - Phone:815-318-5010
Practice Address - Fax:815-941-6431
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3232017OtherBLUE CROSS BLUE SHIELD
ILI20794Medicare UPIN
IL3232017OtherBLUE CROSS BLUE SHIELD