Provider Demographics
NPI:1386064376
Name:P.O.BURGAN M.D. INC.
Entity type:Organization
Organization Name:P.O.BURGAN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:BURGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-438-1647
Mailing Address - Street 1:303 N FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4254
Mailing Address - Country:US
Mailing Address - Phone:765-438-6611
Mailing Address - Fax:765-456-3414
Practice Address - Street 1:303 N FOREST DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4254
Practice Address - Country:US
Practice Address - Phone:765-438-6611
Practice Address - Fax:765-456-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023827A251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable