Provider Demographics
NPI:1962754093
Name:BRAD S BURLEW CARDIOLOGY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRAD S BURLEW CARDIOLOGY A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURLEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-738-5100
Mailing Address - Street 1:1775 BROWNING WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8338
Mailing Address - Country:US
Mailing Address - Phone:775-738-5100
Mailing Address - Fax:775-738-5115
Practice Address - Street 1:1775 BROWNING WAY STE 104
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8338
Practice Address - Country:US
Practice Address - Phone:775-738-5100
Practice Address - Fax:775-738-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGU583AMedicare PIN