Provider Demographics
NPI:1992797872
Name:BURLINGAME, ALAN L (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:BURLINGAME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2121
Mailing Address - Fax:419-479-6017
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2121
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0920410OtherAETNA
MI000000221633OtherANTHEM
OH370012695OtherRRMC
OH000000141244OtherANTHEM
OH02549OtherPHC
OH12-01545OtherUHC
MI3505802271OtherBCBS MI
OH2014671Medicaid
OH10726OtherHPM
MI12-03665OtherUHC
MI5034449OtherAETNA
OHBU0818463Medicare ID - Type Unspecified
MI12-03665OtherUHC